MEDICARE: GENERAL VISION SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization		NY

General Provider Information

NPI Number	:	1043386089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERAL VISION SERVICES LLC

Provider Business Mailing Address
First Line	:	520 8TH AVE
Second Line	:	9TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10018-6507
Country	:	US
Telephone Number	:	212-729-5300
Fax Number	:	212-967-4781

Provider Business Practice Location Address
First Line	:	11510 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1902
Country	:	US
Telephone Number	:	718-323-6410
Fax Number	:	718-323-6375

Authorized Official
Title or Position	:	PROVIDER RELATIONS DIRECTOR
Name	:	MR. VIVEK SRA
Credential	:
Telephone Number	:	212-729-5365

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/22/2020

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