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General NPI Number Information
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NPI Number | 1245261593
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Entity Type | Organization
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Legal Business Name | EYELLUSION VISION CENTER INCORPORATED
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 6909 ROOSEVELT AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-2933
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Country | US
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Telephone | 718-639-1392
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Fax | 718-639-2041
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Provider Business Mailing Address
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Address Line | 6909 ROOSEVELT AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-2933
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Country | US
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Telephone | 718-639-1392
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Fax | 718-639-2041
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HERMINIO V FERNANDEZ
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Credential | OPTICIAN
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Telephone | 718-639-1392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 006666
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License Number State | NY
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