East Main Street Opticians Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

C0058551 Issued in NY

Legal business name

EAST MAIN STREET OPTICIANS INC.

Doing business as

Brookhaven Opticians

Practice address

180 E Main St Ste 4
Patchogue, NY 11772-3171

Phone

(631) 475-5030

Fax

(631) 475-5037

NPI assigned

Mar 23, 2007

Last updated

Sep 17, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul Mastrorocco, OPTICIANNPI 1801041843

Title

President Optician

Phone

(631) 553-6747

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brookhaven Opticians 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, and the practitioner matching its NPPES authorized official.

• Paul Mastrorocco, DISPENSING OPTICIAN

  • Optician
  • Port Jefferson Station, NY
  • NPI 1801041843
  NPD Authorized official

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1982721288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 EAST MAIN STREET",
            "address_2": "SUITE 4",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "11772",
            "telephone_number": "631-475-5030",
            "fax_number": "631-475-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 E MAIN ST STE 4",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723171",
            "telephone_number": "631-475-5030",
            "fax_number": "631-475-5037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MAIN STREET OPTICIANS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "MASTROROCCO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT OPTICIAN",
        "authorized_official_telephone_number": "631-553-6747",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NY",
            "license": "C0058551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00683849",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookhaven Opticians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookhaven Opticians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Patchogue, NY
• Providers in Patchogue, 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 Sep 17, 2021; 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.