Healthcare Provider Details
I. General information
NPI: 1356304976
Provider Name (Legal Business Name): EMPIRE VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/07/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2590 RIDGE RD BUCKMANS PLAZA
WEST ROCHESTER NY
14626
US
IV. Provider business mailing address
2921 ERIE BLVD E
SYRACUSE NY
13224
US
V. Phone/Fax
- Phone: 585-227-7150
- Fax: 585-227-1999
- Phone: 315-446-3145
- Fax: 315-445-7675
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 332H00000X |
| Taxonomy | Eyewear Supplier |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 156F00000X |
| Taxonomy | Technician/Technologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
ALAN
K
THROWER
Title or Position: SVP
Credential:
Phone: 315-446-3145