Healthcare Provider Details

I. General information

NPI: 1619340940
Provider Name (Legal Business Name): EMPIRE VISION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SUNRISE HWY W
PATCHOGUE NY
11772-1905
US

IV. Provider business mailing address

PO BOX 418348
BOSTON MA
02241-8348
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-1235
  • Fax: 631-654-1237
Mailing address:
  • Phone: 800-340-0129
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DOROTHY REYNOLDS
Title or Position: VP RETAIL MANAGED CARE
Credential:
Phone: 210-524-6515