1407984453 NPI number — EMERGING VISION INC

Table of content: (NPI 1407984453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407984453 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:
Provider Other Organization Name Type Code:
6
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:
1407984453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 QUENTIN ROOSEVELT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530-4874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-390-2101
Provider Business Mailing Address Fax Number:
516-390-2110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTES 5 AND 5A
Provider Second Line Business Practice Location Address:
SANGERTOWN MALL
Provider Business Practice Location Address City Name:
NEW HARTFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13413-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-797-3357
Provider Business Practice Location Address Fax Number:
315-797-1134
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
MYLES
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
516-390-2101

Provider Taxonomy Codes

  • Taxonomy code: 156FX1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02579220 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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