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General NPI Number Information
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NPI Number | 1326449513
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Entity Type | Organization
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Legal Business Name | NY VISION GROUP
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 11915 ATLANTIC AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-3216
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Country | US
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Telephone | 718-805-0700
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Fax | 718-805-5621
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Provider Business Mailing Address
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Address Line | 11915 ATLANTIC AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-3216
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Country | US
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Telephone | 718-805-0700
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Fax | 718-805-5621
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MS. YVONNE LOPEZ
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Credential |
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Telephone | 718-805-0700
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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 | TUV008183-1
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License Number State | NY
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