NPIMap

Organization Active NPI

Wynn Optics Corp

  • Optician
  • New York, NY
National Provider Identifier
1366584559
Registry record updated Feb 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
164759 Issued in NY
Legal business name
WYNN OPTICS CORP
Doing business as
WYNN OPITCS
Practice address
167 Malcolm X Blvd
New York, NY 10026-1320
Phone
(212) 222-6048
Fax
(212) 222-6606
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Dejuan Lamont Wynn, OPTICIANNPI 1184805764
Title
Owner
Phone
(212) 222-6048

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X 164759 NY Primary

Addresses

Primary practice location

167 Malcolm X Blvd
New York, NY 10026-1320

Mailing address

167 Malcolm X Blvd
New York, NY 10026-1320
Phone (212) 222-6048

Other names 1

  • WYNN OPITCS Doing business as

National Provider Directory

National Provider Directory

Locations

167 Lenox Ave
#167
New York, NY 10026
Phone (212) 222-6100

167 Malcolm X Blvd
New York, NY 10026
Phone (212) 222-6048

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266883200000",
    "number": "1366584559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 MALCOLM X BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100261320",
            "telephone_number": "212-222-6048",
            "fax_number": "212-222-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 MALCOLM X BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100261320",
            "telephone_number": "212-222-6048",
            "fax_number": "212-222-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYNN OPTICS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2010-02-23",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "DEJUAN",
        "authorized_official_middle_name": "LAMONT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-222-6048",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "164759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WYNN OPITCS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.