1700206067 NPI number — CLEAR VISION OPHTHALMOLOGY PLLC

Table of content: (NPI 1700206067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700206067 NPI number — CLEAR VISION OPHTHALMOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEAR VISION OPHTHALMOLOGY PLLC
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:
1700206067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7910 34TH AVE STE 1Y
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-429-2470
Provider Business Mailing Address Fax Number:
718-247-9793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7910 34TH AVE STE 1Y
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-429-2470
Provider Business Practice Location Address Fax Number:
718-247-9793
Provider Enumeration Date:
04/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
SIDHARAJ
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-429-2470

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  267134 , 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: 03541339 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04003485 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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