Provider Demographics
NPI:1316265895
Name:EMPIRE VISION CENTER INC
Entity type:Organization
Organization Name:EMPIRE VISION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP RETAIL OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-446-7573
Mailing Address - Street 1:1958-62 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:DAVIS VISION
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720
Mailing Address - Country:US
Mailing Address - Phone:631-467-0524
Mailing Address - Fax:631-467-0530
Practice Address - Street 1:1958-62 MIDDLE COUNTRY ROAD
Practice Address - Street 2:DAVIS VISION
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720
Practice Address - Country:US
Practice Address - Phone:631-467-0524
Practice Address - Fax:631-467-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty