=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235538612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE VISION GALLERY LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2014
-----------------------------------------------------
Last Update Date | 08/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2351 HYLAN BLVD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10306-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-668-2222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23511 HYLAN BLVD
-----------------------------------------------------
City | SI
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-668-2222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JAMES CAMPBELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-668-2222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 6571
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------