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	:	1386011542
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	:	800-349-5120
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	455 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4707
Country	:	US
Telephone Number	:	718-238-3296
Fax Number	:	718-238-3561

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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