Provider Demographics
NPI:1699926394
Name:EYE APPEAL MASTERS IN VISION LLC
Entity type:Organization
Organization Name:EYE APPEAL MASTERS IN VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:NYS LIC OPTICIAN
Authorized Official - Phone:585-288-7555
Mailing Address - Street 1:1524 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4241
Mailing Address - Country:US
Mailing Address - Phone:585-288-7555
Mailing Address - Fax:585-288-8998
Practice Address - Street 1:1524 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-4241
Practice Address - Country:US
Practice Address - Phone:585-288-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC 006690-1156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6200510001Medicare NSC