MEDICARE: SOUTHERN VISION CARE PC.

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	UV004778	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	:	1548308430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN VISION CARE PC.

Provider Business Mailing Address
First Line	:	811 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-5202
Country	:	US
Telephone Number	:	718-993-5466
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 SOUTHERN BLVD LBBY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-5202
Country	:	US
Telephone Number	:	718-924-2552
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD LACORTE
Credential	:	OD
Telephone Number	:	718-924-2552

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	02/11/2021

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Directions to “SOUTHERN VISION CARE PC. ” Practice Location

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