=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275721276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUNTER VISION CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2007
-----------------------------------------------------
Last Update Date | 08/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4157 MAIN ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-3132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-939-6888
-----------------------------------------------------
Fax | 718-939-6880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4157 MAIN STREET
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-939-6888
-----------------------------------------------------
Fax | 718-939-6880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. YUCHANG MA
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 718-939-6888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | TUV006549-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------