MEDICARE: EYE SPARKLE OPTICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152WL0500X	Low Vision Rehabilitation Optometrist
2	156FC0801X	Contact Lens Fitter
3	156FX1800X	Optician
4	332H00000X	Eyewear Supplier
5	152W00000X	Optometrist

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	:	1952835167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE SPARKLE OPTICAL CORPORATION

Provider Business Mailing Address
First Line	:	45 EASTDALE AVE N STE 102
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-1796
Country	:	US
Telephone Number	:	845-471-7710
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 EASTDALE AVE N STE 102
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-1796
Country	:	US
Telephone Number	:	845-471-7710
Fax Number	:	845-471-7746

Authorized Official
Title or Position	:	CEO
Name	:	MICHELLE NIEMIEC
Credential	:
Telephone Number	:	845-471-7710

Provider Enumeration Date	:	04/13/2017
Last Update Date	:	04/30/2025

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Directions to “EYE SPARKLE OPTICAL CORPORATION ” Practice Location

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