MEDICARE: MOUNT VERNON VISION CENTER CORPORATION

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1265385975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT VERNON VISION CENTER CORPORATION

Provider Business Mailing Address
First Line	:	418 E SANDFORD BLVD
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-4725
Country	:	US
Telephone Number	:	914-297-2020
Fax Number	:	914-297-2433

Provider Business Practice Location Address
First Line	:	418 E SANDFORD BLVD
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-4725
Country	:	US
Telephone Number	:	914-297-2020
Fax Number	:	914-297-2433

Authorized Official
Title or Position	:	OWNER
Name	:	ANNETTE FAJARDO
Credential	:
Telephone Number	:	917-417-3707

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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