MEDICARE: EMPIRE VISION CENTER, 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1144692989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPIRE VISION CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 418348
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-8348
Country	:	US
Telephone Number	:	800-340-0129
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	222 AIRPORT PLAZA BLVD
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-3946
Country	:	US
Telephone Number	:	631-694-5406
Fax Number	:	631-694-5407

Authorized Official
Title or Position	:	VP, RETAIL MANAGED CARE
Name	:	DOROTHY REYNOLDS
Credential	:
Telephone Number	:	210-524-6515

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	10/20/2015

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