MEDICARE: MR. JOSEPH VISHNEVETSKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	006037	NY

General Provider Information

NPI Number	:	1013187673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH VISHNEVETSKY

Provider Business Mailing Address
First Line	:	1551 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2313
Country	:	US
Telephone Number	:	718-981-3500
Fax Number	:	718-979-0917

Provider Business Practice Location Address
First Line	:	1551 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2313
Country	:	US
Telephone Number	:	718-981-3500
Fax Number	:	718-979-0917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/10/2008

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