Healthcare Provider Details

I. General information

NPI: 1831442995
Provider Name (Legal Business Name): GREEN ACRES VISTASITE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 GREEN ACRES MALL # 118
VALLEY STREAM NY
11581-1535
US

IV. Provider business mailing address

1088 GREEN ACRES MALL # 118
VALLEY STREAM NY
11581-1535
US

V. Phone/Fax

Practice location:
  • Phone: 516-568-2010
  • Fax: 516-568-2060
Mailing address:
  • Phone: 718-547-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006117-1
License Number StateNY

VIII. Authorized Official

Name: MICHAEL ORLOFF
Title or Position: OWNER
Credential:
Phone: 914-523-4295