Healthcare Provider Details

I. General information

NPI: 1063587780
Provider Name (Legal Business Name): IMAGE VISION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CHURCH AVE
BROOKLYN NY
11218-3917
US

IV. Provider business mailing address

119 CHURCH AVE
BROOKLYN NY
11218-3917
US

V. Phone/Fax

Practice location:
  • Phone: 718-436-1848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUTOO6567
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberVUT 005953
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number007466-01
License Number StateNY

VIII. Authorized Official

Name: DAVID LITOVSKY
Title or Position: MANAGER
Credential:
Phone: 718-436-1848