Provider Demographics
NPI:1245403609
Name:HAUPPAUGE VISION INC.
Entity Type:Organization
Organization Name:HAUPPAUGE VISION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-979-0515
Mailing Address - Street 1:555 ROUTE 111
Mailing Address - Street 2:HAUPPAUGE
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4359
Mailing Address - Country:US
Mailing Address - Phone:631-979-0515
Mailing Address - Fax:631-979-6072
Practice Address - Street 1:555 ROUTE 111
Practice Address - Street 2:HAUPPAUGE
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4359
Practice Address - Country:US
Practice Address - Phone:631-979-0515
Practice Address - Fax:631-979-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV3129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0763590001Medicare NSC
NYWEQ131Medicare PIN