MEDICARE: OASIS VISION CENTER

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	005451	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	:	1922066653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS VISION CENTER

Provider Business Mailing Address
First Line	:	7411 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2713
Country	:	US
Telephone Number	:	718-921-4827
Fax Number	:

Provider Business Practice Location Address
First Line	:	7411 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2713
Country	:	US
Telephone Number	:	718-921-4827
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STAVROS PERLEGIS
Credential	:	O.D.
Telephone Number	:	718-921-4827

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	11/18/2008

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