1932403896 NPI number — EMERGING VISION, INC

Table of content: (NPI 1932403896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932403896 NPI number — EMERGING VISION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGING VISION, 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:
STERLING OPTICAL # 233
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:
1932403896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 8TH AVE
Provider Second Line Business Mailing Address:
900
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10018-6507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-729-5345
Provider Business Mailing Address Fax Number:
212-729-5382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3940 ROUTE 251
Provider Second Line Business Practice Location Address:
PERU MALL SUITE F-1
Provider Business Practice Location Address City Name:
PERU
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-220-1928
Provider Business Practice Location Address Fax Number:
815-220-1925
Provider Enumeration Date:
01/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HERSKOWITZ
Authorized Official First Name:
SAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
646-737-1515

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01052011 . This is a "APPLICATION DATE" identifier . This identifiers is of the category "OTHER".




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