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General NPI Number Information
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NPI Number | 1053936633
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Entity Type | Organization
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Legal Business Name | EMPIRE VISION CARE LLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 11 RALPH PL
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City | STATEN ISLAND
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State | NY
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Zip | 10304-4401
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Country | US
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Telephone | 732-443-7638
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Fax |
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Provider Business Mailing Address
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Address Line | 11 RALPH PL
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City | STATEN ISLAND
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State | NY
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Zip | 10304-4401
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Country | US
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Telephone | 732-443-7638
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JUSTIN RICH
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Credential |
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Telephone | 732-443-7638
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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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