Provider Demographics
NPI:1013187673
Name:VISHNEVETSKY, JOSEPH
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:VISHNEVETSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:VISHNEVETSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:1551 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2313
Mailing Address - Country:US
Mailing Address - Phone:718-981-3500
Mailing Address - Fax:718-979-0917
Practice Address - Street 1:1551 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2313
Practice Address - Country:US
Practice Address - Phone:718-981-3500
Practice Address - Fax:718-979-0917
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist