MEDICARE: GENERAL VISION SERVICES OF STATEN ISLAND LLC

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

General Provider Information

NPI Number	:	1528749868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERAL VISION SERVICES OF STATEN ISLAND LLC

Provider Business Mailing Address
First Line	:	2303 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3918
Country	:	US
Telephone Number	:	718-587-5660
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3918
Country	:	US
Telephone Number	:	718-587-5660
Fax Number	:

Authorized Official
Title or Position	:	OD
Name	:	ARTHUR VAYNER
Credential	:
Telephone Number	:	917-202-6624

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	07/28/2023

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