Healthcare Provider Details

I. General information

NPI: 1316265895
Provider Name (Legal Business Name): EMPIRE VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958-62 MIDDLE COUNTRY ROAD DAVIS VISION
CENTEREACH NY
11720
US

IV. Provider business mailing address

1958-62 MIDDLE COUNTRY ROAD DAVIS VISION
CENTEREACH NY
11720
US

V. Phone/Fax

Practice location:
  • Phone: 631-467-0524
  • Fax: 631-467-0530
Mailing address:
  • Phone: 631-467-0524
  • Fax: 631-467-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS J ROSA
Title or Position: SENIOR VP RETAIL OPERATIONS
Credential:
Phone: 315-446-7573