Healthcare Provider Details

I. General information

NPI: 1154752574
Provider Name (Legal Business Name): VICTOR FAMILY EYECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6534 ANTHONY DR
VICTOR NY
14564-1403
US

IV. Provider business mailing address

6534 ANTHONY DR SUITE B
VICTOR NY
14564-1403
US

V. Phone/Fax

Practice location:
  • Phone: 585-944-7201
  • Fax:
Mailing address:
  • Phone: 585-398-7545
  • Fax: 585-398-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number006892
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number006353
License Number StateNY

VIII. Authorized Official

Name: DR. ROY KIM
Title or Position: PRESIDENT/OPTOMETRIST
Credential: OD
Phone: 585-944-7201