MEDICARE: ENVISION FAMILY EYE CARE, P.C.

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	152WC0802X	Corneal and Contact Management Optometrist	TUV3121	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	:	1376608844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION FAMILY EYE CARE, P.C.

Provider Business Mailing Address
First Line	:	454 WARREN ST
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-2445
Country	:	US
Telephone Number	:	518-828-0215
Fax Number	:	518-828-0859

Provider Business Practice Location Address
First Line	:	454 WARREN ST
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-2445
Country	:	US
Telephone Number	:	518-828-0215
Fax Number	:	518-828-0859

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ARNOLD ERIK NATHANSON
Credential	:	O.D.
Telephone Number	:	518-828-0215

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	08/22/2020

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