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General NPI Number Information
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NPI Number | 1144392549
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Entity Type | Organization
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Legal Business Name | BUENA VISTA VISION CENTER, INC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 3777 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10032-1541
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Country | US
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Telephone | 212-926-0336
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Fax | 212-926-0212
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Provider Business Mailing Address
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Address Line | 3777 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10032-1541
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Country | US
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Telephone | 212-926-0336
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Fax | 212-926-0212
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS ALBERTO DE LA ROSA
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Credential | OD
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Telephone | 212-926-0336
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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 | TUV005619
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License Number State | NY
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