MEDICARE: IMAGE VISION SERVICES INC

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	152WV0400X	Vision Therapy Optometrist	VUT 005953	NY
2	156FX1800X	Optician	007466-01	NY
3	152W00000X	Optometrist	VUTOO6567	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063587780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGE VISION SERVICES INC

Provider Business Mailing Address
First Line	:	119 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3917
Country	:	US
Telephone Number	:	718-436-1848
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DAVID LITOVSKY
Credential	:
Telephone Number	:	718-436-1848

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	10/28/2013

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