Provider Demographics
NPI:1366423493
Name:CORAM HILLS EYECARE OPTOMETRY & OPTHALMIC DISPENSING PLLC
Entity type:Organization
Organization Name:CORAM HILLS EYECARE OPTOMETRY & OPTHALMIC DISPENSING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLTELLINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-732-0822
Mailing Address - Street 1:592 MILL RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-4114
Mailing Address - Country:US
Mailing Address - Phone:631-732-0822
Mailing Address - Fax:631-732-0018
Practice Address - Street 1:592 MILL RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4114
Practice Address - Country:US
Practice Address - Phone:631-732-0822
Practice Address - Fax:631-732-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02160869Medicaid