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General NPI Number Information
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NPI Number | 1134892763
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Entity Type | Organization
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Legal Business Name | LONG ISLAND VISION AND CONTACT LENS SERVICES, INC.
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 160 WALT WHITMAN RD STE 1021B
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-4160
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Country | US
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Telephone | 631-714-6030
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Fax |
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Provider Business Mailing Address
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Address Line | 160 WALT WHITMAN RD STE 1021B
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-4160
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Country | US
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Telephone | 631-714-6030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL VACCARELLA
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Credential | OD
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Telephone | 631-714-3030
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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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