=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417938150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHEELS OF VISION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2005
-----------------------------------------------------
Last Update Date | 12/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13809 QUEENS BLVD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11435-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-739-6507
-----------------------------------------------------
Fax | 718-523-7466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13809 QUEENS BLVD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11435-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-739-6507
-----------------------------------------------------
Fax | 718-523-7466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTICIAN MANAGER
-----------------------------------------------------
Name | MR. ROBERT PHILLIP KAPLAN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 718-739-6507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 004661
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------