Healthcare Provider Details

I. General information

NPI: 1255875514
Provider Name (Legal Business Name): SVC OF EAST SETAUKET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HALLOCK RD STE 2
STONY BROOK NY
11790-3077
US

IV. Provider business mailing address

1224 OSTRANDER AVENUE
RIVERHEAD NY
11901
US

V. Phone/Fax

Practice location:
  • Phone: 631-675-6909
  • Fax: 631-675-6910
Mailing address:
  • Phone: 631-727-2858
  • Fax: 631-727-2866

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: JEFFREY S WILLIAMS
Title or Position: OWNER
Credential: OD
Phone: 631-727-7858