1982667390 NPI number — EMPIRE VISION CENTER INC

Table of content: (NPI 1982667390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982667390 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:
1982667390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2921 ERIE BLVD EAST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13224-1430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-446-3145
Provider Business Mailing Address Fax Number:
315-445-7675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2799 ROUTE 112 STE 2A
Provider Second Line Business Practice Location Address:
KING KULLEN SHOPPING CENTER
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11763-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-289-3937
Provider Business Practice Location Address Fax Number:
631-207-0913
Provider Enumeration Date:
04/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THROWER
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
SVP
Authorized Official Telephone Number:
315-446-3145

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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