MEDICARE: EASTVIEW VISION INC

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	156FX1800X	Optician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8786	OTHER	NY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1114900651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTVIEW VISION INC

Provider Business Mailing Address
First Line	:	PO BOX 162
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-0162
Country	:	US
Telephone Number	:	585-394-1128
Fax Number	:	585-394-6877

Provider Business Practice Location Address
First Line	:	6081 ROUTE 96 S
Second Line	:	STE 8
City	:	FARMINGTON
State	:	NY
Zip	:	14425
Country	:	US
Telephone Number	:	585-924-2550
Fax Number	:	585-924-4399

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. TERRY L JOHNSON
Credential	:
Telephone Number	:	585-394-1128

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	08/22/2020

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Directions to “EASTVIEW VISION INC ” Practice Location

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