=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851413157
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITILIGHT VISION CARE, O.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1491 3RD AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-396-4793
-----------------------------------------------------
Fax | 212-396-4793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1491 3RD AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-396-4793
-----------------------------------------------------
Fax | 212-396-4793
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALICE CHEN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 212-396-4793
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 006416
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------