Provider Demographics
NPI:1386713394
Name:AMERICAN EYE CARE CENTER, INC.
Entity type:Organization
Organization Name:AMERICAN EYE CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:STADLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-956-3000
Mailing Address - Street 1:38 03 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4058
Mailing Address - Country:US
Mailing Address - Phone:718-956-3000
Mailing Address - Fax:718-204-0227
Practice Address - Street 1:38 03 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4058
Practice Address - Country:US
Practice Address - Phone:718-956-3000
Practice Address - Fax:718-204-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695345Medicaid
NYG100000407Medicare UPIN
NY42262Medicare PIN
T91833Medicare UPIN