Healthcare Provider Details

I. General information

NPI: 1780266437
Provider Name (Legal Business Name): EMERGING VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6081 ROUTE 96 STE 8
FARMINGTON NY
14425-1062
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 585-924-2550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

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