Provider Demographics
NPI:1356834634
Name:REYES VISION, INC.
Entity Type:Organization
Organization Name:REYES VISION, INC.
Other - Org Name:REYES VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:347-789-7978
Mailing Address - Street 1:1571 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4261
Mailing Address - Country:US
Mailing Address - Phone:212-543-3937
Mailing Address - Fax:
Practice Address - Street 1:1571 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4261
Practice Address - Country:US
Practice Address - Phone:212-543-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008564-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid