Provider Demographics
NPI:1598017493
Name:GVC VISION 1, INC
Entity type:Organization
Organization Name:GVC VISION 1, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-684-5000
Mailing Address - Street 1:1704 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2630
Mailing Address - Country:US
Mailing Address - Phone:718-684-5000
Mailing Address - Fax:718-684-5004
Practice Address - Street 1:1704 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2630
Practice Address - Country:US
Practice Address - Phone:718-684-5000
Practice Address - Fax:718-684-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100080035Medicare PIN