Healthcare Provider Details

I. General information

NPI: 1235804865
Provider Name (Legal Business Name): JYM VISION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 NORTHFIELD AVE
STATEN ISLAND NY
10303
US

IV. Provider business mailing address

294 COLONY AVE
STATEN ISLAND NY
10306-5949
US

V. Phone/Fax

Practice location:
  • Phone: 917-771-9899
  • Fax:
Mailing address:
  • Phone: 917-771-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE MENDEZ
Title or Position: MANAGER
Credential:
Phone: 347-670-0760