Organization
PORT JEFFERSON OPTICIANS INC
Active
Other names
Brookhaven Opticians
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL MASTROROCCO OPTICIAN (PRESIDENT/OPTICIAN)
(631) 331-0600
Entity
Organization
Contact information
Practice address
208 ROUTE 112 STE 2, PORT JEFFERSON STATION, NY 11776-1013
(631) 331-0600
(631) 331-0809
Mailing address
208 ROUTE 112 STE 2, PORT JEFFERSON STATION, NY 11776-1013
(631) 331-0600
(631) 331-0809
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01934578
—
NY
Enumeration date
04/03/2007
Last updated
09/17/2021
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