Healthcare Provider Details

I. General information

NPI: 1952835167
Provider Name (Legal Business Name): EYE SPARKLE OPTICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 EASTDALE AVE N STE 102
POUGHKEEPSIE NY
12603-1796
US

IV. Provider business mailing address

45 EASTDALE AVE N STE 102
POUGHKEEPSIE NY
12603-1796
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-7710
  • Fax: 845-471-7746
Mailing address:
  • Phone: 845-471-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE NIEMIEC
Title or Position: CEO
Credential:
Phone: 845-471-7710