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General NPI Number Information
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NPI Number | 1033715552
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Entity Type | Organization
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Legal Business Name | MOUNT VERNON EYE CARE
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 108 GRAMATAN AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-1306
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Country | US
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Telephone | 914-663-8010
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Fax | 914-663-8010
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Provider Business Mailing Address
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Address Line | 108 GRAMATAN AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-1306
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Country | US
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Telephone | 914-663-8010
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Fax | 914-663-8010
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILIP VENTICINQUE
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Credential |
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Telephone | 914-384-0923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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