Provider Demographics
NPI:1326183252
Name:ULTRA VISION OPTICAL CENTER INC
Entity Type:Organization
Organization Name:ULTRA VISION OPTICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-796-2020
Mailing Address - Street 1:812 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1262
Mailing Address - Country:US
Mailing Address - Phone:516-796-2020
Mailing Address - Fax:516-796-3818
Practice Address - Street 1:812 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1262
Practice Address - Country:US
Practice Address - Phone:516-796-2020
Practice Address - Fax:516-796-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
NYTUV006342305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC056J1Medicare UPIN