Organization
MAMMOTH OPTICAL
Active
Other names
stony brook vision world
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW NEIL POLAN (PRESITDENT)
(631) 246-5468
Entity
Organization
Contact information
Practice address
2194 NESCONSET HWY STE A, STONY BROOK, NY 11790-3500
(631) 246-5468
(631) 246-5442
Mailing address
2194 NESCONSET HWY STE A, STONY BROOK, NY 11790-3500
(631) 246-5468
(631) 246-5442
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
6197
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01679698
—
NY
Enumeration date
01/12/2007
Last updated
08/22/2020
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