Healthcare Provider Details

I. General information

NPI: 1366933707
Provider Name (Legal Business Name): METROPOLITAN VISION OPTOMETRY DOWNTOWN PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SAINT JAMES PL
NEW YORK NY
10038-1209
US

IV. Provider business mailing address

22 W 13TH ST
NEW YORK NY
10011-7902
US

V. Phone/Fax

Practice location:
  • Phone: 212-807-0019
  • Fax: 212-727-2395
Mailing address:
  • Phone: 212-807-0019
  • Fax: 212-727-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006664
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV006664
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTUV006664
License Number StateNY

VIII. Authorized Official

Name: DR. TRACI M GOLDSTEIN
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 212-807-0019