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

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 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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