Healthcare Provider Details

I. General information

NPI: 1326183252
Provider Name (Legal Business Name): ULTRA VISION OPTICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 HICKSVILLE RD
N MASSAPEQUA NY
11758-1262
US

IV. Provider business mailing address

812 HICKSVILLE RD
N MASSAPEQUA NY
11758-1262
US

V. Phone/Fax

Practice location:
  • Phone: 516-796-2020
  • Fax: 516-796-3818
Mailing address:
  • Phone: 516-796-2020
  • Fax: 516-796-3818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberTUV006342
License Number StateNY

VIII. Authorized Official

Name: DR. JASON BART
Title or Position: OPTOMETRIST
Credential: OD
Phone: 516-796-2020