Healthcare Provider Details

I. General information

NPI: 1871164194
Provider Name (Legal Business Name): NYC VISION CAPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2264 BROADWAY
NEW YORK NY
10024-5403
US

IV. Provider business mailing address

6803 KENNEDY BLVD E APT 45
GUTTENBERG NJ
07093-4510
US

V. Phone/Fax

Practice location:
  • Phone: 347-894-1424
  • Fax:
Mailing address:
  • Phone: 347-894-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIE ISLAM
Title or Position: EXECUTIVE DIRECTOR
Credential: OD
Phone: 347-894-1424