Provider Demographics
NPI:1326449513
Name:NY VISION GROUP
Entity Type:Organization
Organization Name:NY VISION GROUP
Other - Org Name:HARRY R KOSTER MD PC DBA NY VISION GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-805-0700
Mailing Address - Street 1:11915 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3216
Mailing Address - Country:US
Mailing Address - Phone:718-805-0700
Mailing Address - Fax:718-805-5621
Practice Address - Street 1:11915 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-3216
Practice Address - Country:US
Practice Address - Phone:718-805-0700
Practice Address - Fax:718-805-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008183-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty