MEDICARE: EMERGING VISION

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	156FX1100X	Ophthalmic Technician/Technologist

General Provider Information

NPI Number	:	1538368410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGING VISION

Provider Business Mailing Address
First Line	:	100 QUENTIN ROOSEVELT BLVD
Second Line	:	508
City	:	GARDEN CITY
State	:	NY
Zip	:	11530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 LITTLE PATUXENT PKWY
Second Line	:	COLUMBIA MALL
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3341
Country	:	US
Telephone Number	:	410-884-6500
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MYLES LEWIS
Credential	:
Telephone Number	:	516-390-2101

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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Directions to “EMERGING VISION ” Practice Location

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