MEDICARE: MK VISION CENTER STATEN ISLAND LLC

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	:	1922706779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MK VISION CENTER STATEN ISLAND LLC

Provider Business Mailing Address
First Line	:	1803 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3515
Country	:	US
Telephone Number	:	845-495-3658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3515
Country	:	US
Telephone Number	:	845-495-3658
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL MA
Credential	:
Telephone Number	:	646-203-8979

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	03/07/2024

Similar Medicare Providers

1962244657 — LIFELINE PHARMACY INCORPORATED
Practice Location Address:

1807 VICTORY BLVD
STATEN ISLAND, NY
10314-3515

Practice Phone: 718-304-2211
Practice Fax: 718-304-2231

1063549541 — ALAN FRUCHTMAN OPTICIAN
Practice Location Address:

1803 VICTORY BLVD
STATEN ISLAND, NY
10314-3515

Practice Phone: 718-448-7676
Practice Fax: 718-448-7675

1619096815 — STATEN EYE LAND 2 INC
Practice Location Address:

1803 VICTORY BLVD
STATEN ISLAND, NY
10314-3515

Practice Phone: 718-448-7676
Practice Fax: 718-448-7675

1982940763 — STATEN ISLAND PHARMACY INC.
Practice Location Address:

1807 VICTORY BLVD
STATEN ISLAND, NY
10314-3515

Practice Phone: 718-448-5200
Practice Fax: 718-448-5311

1588252423 — KJ OPTOMETRY PLLC
Practice Location Address:

1803 VICTORY BLVD
STATEN ISLAND, NY
10314-3515

Practice Phone: 718-975-4824
Practice Fax:

1952080517 — TIFFANY CHEN OD
Practice Location Address:

1803 VICTORY BLVD
STATEN ISLAND, NY
10314-3515

Practice Phone: 845-495-3658
Practice Fax:

Directions to “MK VISION CENTER STATEN ISLAND LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.