=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689462947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARLEM VISION GROUP INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2025
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 LENOX AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10037-0982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-368-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 455 LENOX AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10037-0982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-368-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ARIELLE ROBERTS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 305-282-0535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------