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
2	156F00000X	Technician/Technologist

General Provider Information

NPI Number	:	1780649640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPIRE VISION CENTER INC

Provider Business Mailing Address
First Line	:	2921 ERIE BLVD EAST
Second Line	:	EMPIRE VISION CENTER INC
City	:	SYRACUSE
State	:	NY
Zip	:	13224
Country	:	US
Telephone Number	:	315-446-3145
Fax Number	:	315-445-7675

Provider Business Practice Location Address
First Line	:	45A NEWPORT AVE
Second Line	:	VISION WORLD
City	:	RUMFORD
State	:	RI
Zip	:	02916-2070
Country	:	US
Telephone Number	:	401-434-9870
Fax Number	:	401-435-8037

Authorized Official
Title or Position	:	SVP
Name	:	MR. ALAN K THROWER
Credential	:
Telephone Number	:	315-446-3145

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	04/10/2009

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