Provider Demographics
NPI:1699974642
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:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOLSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:726-444-4078
Mailing Address - Street 1:159 EXPRESS ST
Mailing Address - Street 2:DAVIS VISION
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2404
Mailing Address - Country:US
Mailing Address - Phone:516-827-6727
Mailing Address - Fax:516-733-5508
Practice Address - Street 1:8511 126TH ST
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3312
Practice Address - Country:US
Practice Address - Phone:718-849-7773
Practice Address - Fax:718-849-7780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPIRE VISION CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0505220097Medicare NSC