MEDICARE: NYC VISION CAPITAL INC

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	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1871164194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC VISION CAPITAL INC

Provider Business Mailing Address
First Line	:	6803 KENNEDY BLVD E APT 45
Second Line	:
City	:	GUTTENBERG
State	:	NJ
Zip	:	07093-4510
Country	:	US
Telephone Number	:	347-894-1424
Fax Number	:

Provider Business Practice Location Address
First Line	:	2264 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5403
Country	:	US
Telephone Number	:	347-894-1424
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELIE ISLAM
Credential	:	OD
Telephone Number	:	347-894-1424

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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Directions to “NYC VISION CAPITAL INC ” Practice Location

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