Healthcare Provider Details

I. General information

NPI: 1366423493
Provider Name (Legal Business Name): CORAM HILLS EYECARE OPTOMETRY & OPTHALMIC DISPENSING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 MILL RD
CORAM NY
11727-4114
US

IV. Provider business mailing address

592 MILL RD
CORAM NY
11727-4114
US

V. Phone/Fax

Practice location:
  • Phone: 631-732-0822
  • Fax: 631-732-0018
Mailing address:
  • Phone: 631-732-0822
  • Fax: 631-732-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. VINCENT COLTELLINO
Title or Position: PRINCIPAL PARTNER
Credential: OD
Phone: 631-732-0822