Healthcare Provider Details

I. General information

NPI: 1235529330
Provider Name (Legal Business Name): HERALD SQUARE EYECARE OPTOMETRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 AVENUE OF THE AMERICAS SUITE 205
NEW YORK NY
10001-3505
US

IV. Provider business mailing address

115 SULLIVAN ST 3AF
NEW YORK NY
10012-5603
US

V. Phone/Fax

Practice location:
  • Phone: 212-967-4177
  • Fax:
Mailing address:
  • Phone: 614-584-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007598
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number007598
License Number StateNY

VIII. Authorized Official

Name: DR. MY-HANH VU
Title or Position: PRESIDENT
Credential: O.D.
Phone: 614-584-1081