=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699974642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPIRE VISION CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 10/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8511 126TH ST
-----------------------------------------------------
City | KEW GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11415-3312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-849-7773
-----------------------------------------------------
Fax | 718-849-7780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 159 EXPRESS ST DAVIS VISION
-----------------------------------------------------
City | PLAINVIEW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11803-2404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-827-6727
-----------------------------------------------------
Fax | 516-733-5508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DOLSIE MCDONALD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 726-444-4078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 156F00000X
-----------------------------------------------------
Taxonomy Name | Technician/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------