Provider Demographics
NPI:1003569393
Name:EYECOR INC
Entity Type:Organization
Organization Name:EYECOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:YEZRIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-915-6740
Mailing Address - Street 1:2681 PALISADES CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-6406
Mailing Address - Country:US
Mailing Address - Phone:845-358-9001
Mailing Address - Fax:
Practice Address - Street 1:2681 PALISADES CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-6406
Practice Address - Country:US
Practice Address - Phone:845-358-9001
Practice Address - Fax:845-358-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty