Healthcare Provider Details

I. General information

NPI: 1265739007
Provider Name (Legal Business Name): EYECARE ADVANTAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 E FORDHAM RD
BRONX NY
10458-5005
US

IV. Provider business mailing address

1953 GRAND AVE
NORTH BALDWIN NY
11510-2820
US

V. Phone/Fax

Practice location:
  • Phone: 855-423-3700
  • Fax: 631-499-3062
Mailing address:
  • Phone: 855-423-3700
  • Fax: 631-499-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3162
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberT003162
License Number StateNY

VIII. Authorized Official

Name: DR. STEPHEN H ASHINOFF
Title or Position: PRESIDENT
Credential: OD
Phone: 855-423-3700