1164644852 NPI number — OPTOMETRIC EYECARE OF ROCKLAND, P.C.

Table of content: (NPI 1164644852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164644852 NPI number — OPTOMETRIC EYECARE OF ROCKLAND, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTOMETRIC EYECARE OF ROCKLAND, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164644852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 176
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONGERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10920-0176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-267-2888
Provider Business Mailing Address Fax Number:
845-267-3305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONGERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10920-2255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-267-2888
Provider Business Practice Location Address Fax Number:
845-267-3305
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ENG
Authorized Official First Name:
KARL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-267-2888

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV005356 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2466353 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28042 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7707619 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 182985P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 402 . This is a "CSEA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160497 . This is a "COLE VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3684202 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6501812 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 960497 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01657941 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1276051 . This is a "EYEMED HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44768 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3207717 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3C6999 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 905625 . This is a "BLOCK VISION" identifier . This identifiers is of the category "OTHER".




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