1316265895 NPI number — EMPIRE VISION CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316265895 NPI number — EMPIRE VISION CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPIRE VISION CENTER INC
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:
DAVIS VISION
Provider Other Organization Name Type Code:
3
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:
1316265895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1958-62 MIDDLE COUNTRY ROAD
Provider Second Line Business Mailing Address:
DAVIS VISION
Provider Business Mailing Address City Name:
CENTEREACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-467-0524
Provider Business Mailing Address Fax Number:
631-467-0530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1958-62 MIDDLE COUNTRY ROAD
Provider Second Line Business Practice Location Address:
DAVIS VISION
Provider Business Practice Location Address City Name:
CENTEREACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-467-0524
Provider Business Practice Location Address Fax Number:
631-467-0530
Provider Enumeration Date:
05/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROSA
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SENIOR VP RETAIL OPERATIONS
Authorized Official Telephone Number:
315-446-7573

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 156F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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