Healthcare Provider Details

I. General information

NPI: 1770760308
Provider Name (Legal Business Name): MT PLEASANT VISION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 COLUMBUS AVE 3-3
THORNWOOD NY
10594-1909
US

IV. Provider business mailing address

660 COLUMBUS AVE 3-3
THORNWOOD NY
10594-1909
US

V. Phone/Fax

Practice location:
  • Phone: 914-747-2000
  • Fax: 914-747-4032
Mailing address:
  • Phone: 914-747-2000
  • Fax: 914-747-4032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5840
License Number StateNY

VIII. Authorized Official

Name: DR. ANDREA S KAISER
Title or Position: OPTOMETRIST
Credential: OD
Phone: 914-747-2000