MEDICARE: BAYSIDE FAMILY VISION CORP

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	:	1598160152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSIDE FAMILY VISION CORP

Provider Business Mailing Address
First Line	:	10425 JAMAICA AVE
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10425 JAMAICA AVE
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2012
Country	:	US
Telephone Number	:	917-903-8161
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VLADIMIR POLEY
Credential	:	OD
Telephone Number	:	917-903-8161

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	10/06/2023

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Directions to “BAYSIDE FAMILY VISION CORP ” Practice Location

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