Provider Demographics
NPI:1053711473
Name:NORTH STAR OPTICAL, LLC
Entity type:Organization
Organization Name:NORTH STAR OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROCCO
Authorized Official - Last Name:ROBILOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-518-1909
Mailing Address - Street 1:203 W 121ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6218
Mailing Address - Country:US
Mailing Address - Phone:917-518-1909
Mailing Address - Fax:888-612-1315
Practice Address - Street 1:5710 DENALI ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1342
Practice Address - Country:US
Practice Address - Phone:907-444-8854
Practice Address - Fax:888-612-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK252152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1618715Medicaid