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General NPI Number Information
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NPI Number | 1922706779
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Entity Type | Organization
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Legal Business Name | MK VISION CENTER STATEN ISLAND LLC
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 1803 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3515
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Country | US
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Telephone | 845-495-3658
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3515
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Country | US
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Telephone | 845-495-3658
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL MA
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Credential |
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Telephone | 646-203-8979
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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 |
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License Number State |
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