MEDICARE: VISION LIGHT LLC

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	152WC0802X	Corneal and Contact Management Optometrist
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1881340925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION LIGHT LLC

Provider Business Mailing Address
First Line	:	10518 METROPOLITAN AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3808 UNION ST # 3P02
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5543
Country	:	US
Telephone Number	:	929-303-3575
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHIH CHUN TAI
Credential	:
Telephone Number	:	718-971-0651

Provider Enumeration Date	:	02/28/2022
Last Update Date	:	02/28/2022

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Directions to “VISION LIGHT LLC ” Practice Location

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