Mammoth Optical

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

6197 Issued in NY

Legal business name

MAMMOTH OPTICAL

Practice address

2194 Nesconset Hwy Ste a
Stony Brook, NY 11790-3500

Phone

(631) 246-5468

Fax

(631) 246-5442

NPI assigned

Jan 12, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Andrew Neil PolanNPI 1558411165

Title

Presitdent

Phone

(631) 246-5468

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• stony brook vision world Doing business as

Locations

Practitioners 1

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

• Andrew Neil Polan

  • Optician
  • Stony Brook, NY
  • NPI 1558411165
  NPD (past) Authorized official

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487705018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2194 NESCONSET HWY STE A",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903500",
            "telephone_number": "631-246-5468",
            "fax_number": "631-246-5442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2194 NESCONSET HWY STE A",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903500",
            "telephone_number": "631-246-5468",
            "fax_number": "631-246-5442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAMMOTH OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLAN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "NEIL",
        "authorized_official_title_or_position": "PRESITDENT",
        "authorized_official_telephone_number": "631-246-5468",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "6197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01679698",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "stony brook vision world",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Somair Malik, MD/MBA
• Umer Ejaz Malik, M.D.
• William Kinney Mallon Jr., MD
• Katherine Ann Malloy, PA
• Lauren Marie Maloney, M.D.
• Linda Mamone
• Rachel Manci, MD
• Alyssa Joan Mancini, MD
• Logan J Mancuso, MD
• Violet Ann Mandracchia, MA CEAS LCSW

• Durable Medical Equipment & Medical Supplies in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Durable Medical Equipment & Medical Supplies in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.