Provider Demographics
NPI:1164680062
Name:MOUNT KISCO FAMILY VISION CARE
Entity Type:Organization
Organization Name:MOUNT KISCO FAMILY VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:LANDESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:914-241-2020
Mailing Address - Street 1:103 S BEDFORD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3452
Mailing Address - Country:US
Mailing Address - Phone:914-241-2020
Mailing Address - Fax:914-241-0034
Practice Address - Street 1:103 S BEDFORD RD STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3452
Practice Address - Country:US
Practice Address - Phone:914-241-2020
Practice Address - Fax:914-241-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4148152W00000X, 152WL0500X, 152WX0102X
NY2932152W00000X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1202240001Medicare NSC
NYC33102Medicare PIN
NYT48998Medicare UPIN
NYC31562Medicare PIN
NYT49086Medicare UPIN