Healthcare Provider Details

I. General information

NPI: 1962530097
Provider Name (Legal Business Name): EMERGING VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SPOTSYLVANIA MALL
FREDERICKSBURG VA
22407
US

IV. Provider business mailing address

100 QUENTIN ROOSEVELT BLVD 508
GARDEN CITY NY
11530-4874
US

V. Phone/Fax

Practice location:
  • Phone: 540-786-2272
  • Fax: 540-786-3793
Mailing address:
  • Phone: 516-390-2101
  • Fax: 516-390-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MYLES LEWIS
Title or Position: COO
Credential:
Phone: 516-390-2101