Healthcare Provider Details

I. General information

NPI: 1659559862
Provider Name (Legal Business Name): SUMMIT VISION CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ISLIP AVE SUITE 12
ISLIP NY
11751-3222
US

IV. Provider business mailing address

150 ISLIP AVE SUITE 12
ISLIP NY
11751-3222
US

V. Phone/Fax

Practice location:
  • Phone: 631-581-5100
  • Fax: 631-581-7512
Mailing address:
  • Phone: 631-581-5100
  • Fax: 631-581-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004284
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE FORUR
Title or Position: PRES.
Credential: O.D.
Phone: 631-581-5100