Mineola Optical Boutique Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

3126 Issued in NY

Legal business name

MINEOLA OPTICAL BOUTIQUE INC

Practice address

330 Old Country Rd
Suite 100
Mineola, NY 11501-4187

Phone

(516) 248-5554

Fax

(516) 739-6620

NPI assigned

Jan 29, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Peter A. Bacotti, OPHTHALMIC DISPENSER

Title

Manager

Phone

(516) 248-5554

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780720748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 OLD COUNTRY RD",
            "address_2": "SUITE 100",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014187",
            "telephone_number": "516-248-5554",
            "fax_number": "516-739-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 OLD COUNTRY RD",
            "address_2": "SUITE 100",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014187",
            "telephone_number": "516-248-5554",
            "fax_number": "516-739-6620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINEOLA OPTICAL BOUTIQUE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BACOTTI",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "516-248-5554",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPHTHALMIC DISPENSER"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NY",
            "license": "3126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Mineola, NY
• Providers in Mineola, NY by specialty
• Eyewear Supplier 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.