Organization
MIDCREST OPTICAL CORPORATION
Active
Other names
Creston Optical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS BERGER (DIRECTOR OF OPERATIONS)
(212) 582-5926
Entity
Organization
Contact information
Practice address
897 8TH AVE, NEW YORK, NY 10019-5154
(212) 582-5926
Mailing address
897 8TH AVE, NEW YORK, NY 10019-5154
(212) 582-5926
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
VUT002933-1
NY
152WC0802X
Corneal and Contact Management Optometrist
VUT002933-1
NY
152WP0200X
Pediatric Optometrist
VUT002933-1
NY
152WS0006X
Sports Vision Optometrist
VUT002933-1
NY
152WX0102X
Occupational Vision Optometrist
VUT002933-1
NY
156FC0801X
Contact Lens Fitter
5104-1
NY
156FX1800X
Optician
005104-1
NY
332B00000X
Durable Medical Equipment & Medical Supplies
C005104-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00328267
—
NY
Enumeration date
05/30/2007
Last updated
10/10/2011
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