Healthcare Provider Details

I. General information

NPI: 1487562765
Provider Name (Legal Business Name): EMERGING VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10079 SAICH WAY
CUPERTINO CA
95014-2124
US

IV. Provider business mailing address

100 QUENTIN ROOSEVELT BLVD STE 101
GARDEN CITY NY
11530-4843
US

V. Phone/Fax

Practice location:
  • Phone: 408-255-8100
  • Fax:
Mailing address:
  • Phone: 858-414-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS SHASHATI
Title or Position: CREDENTIALING
Credential:
Phone: 646-737-1500