Provider Demographics
NPI:1174835615
Name:BRONXVILLE VISION CARE
Entity Type:Organization
Organization Name:BRONXVILLE VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLO RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-949-8900
Mailing Address - Street 1:10 PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708
Mailing Address - Country:US
Mailing Address - Phone:914-949-8900
Mailing Address - Fax:914-286-3042
Practice Address - Street 1:10 PARK PLACE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708
Practice Address - Country:US
Practice Address - Phone:914-949-8900
Practice Address - Fax:914-286-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty