MEDICARE: SAYVILLE FAMILY EYE CARE

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	TUV004395-1	NY

General Provider Information

NPI Number	:	1659539542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAYVILLE FAMILY EYE CARE

Provider Business Mailing Address
First Line	:	15 GREELEY AVE
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-2605
Country	:	US
Telephone Number	:	631-589-1850
Fax Number	:	631-589-7313

Provider Business Practice Location Address
First Line	:	15 GREELEY AVE
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-2605
Country	:	US
Telephone Number	:	631-589-1850
Fax Number	:	631-589-7313

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY DISANTO
Credential	:	O.D.
Telephone Number	:	631-553-5355

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	05/28/2008

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