Healthcare Provider Details

I. General information

NPI: 1659527596
Provider Name (Legal Business Name): STONY BROOK VISION CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 ROUTE 25A
SETAUKET NY
11733-2947
US

IV. Provider business mailing address

175 ROUTE 25A
SETAUKET NY
11733-2947
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-6655
  • Fax: 631-751-6077
Mailing address:
  • Phone: 631-751-6655
  • Fax: 631-751-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberU002724
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD S GOLDSMITH
Title or Position: PRESIDENT
Credential: OD
Phone: 631-751-6655