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General NPI Number Information
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NPI Number | 1063587780
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Entity Type | Organization
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Legal Business Name | IMAGE VISION SERVICES INC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 119 CHURCH AVE
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City | BROOKLYN
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State | NY
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Zip | 11218-3917
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Country | US
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Telephone | 718-436-1848
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Fax |
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Provider Business Mailing Address
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Address Line | 119 CHURCH AVE
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City | BROOKLYN
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State | NY
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Zip | 11218-3917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DAVID LITOVSKY
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Credential |
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Telephone | 718-436-1848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | VUT 005953
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 007466-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | VUTOO6567
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License Number State | NY
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