Healthcare Provider Details

I. General information

NPI: 1952559833
Provider Name (Legal Business Name): MGL VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREEN ACRES MALL
VALLEY STREAM NY
11581-1533
US

IV. Provider business mailing address

1000 GREEN ACRES MALL
VALLEY STREAM NY
11581-1533
US

V. Phone/Fax

Practice location:
  • Phone: 516-823-4267
  • Fax:
Mailing address:
  • Phone: 516-823-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. GARY EPPEL
Title or Position: MANAGER
Credential: OD
Phone: 516-823-4267