Provider Demographics
NPI:1417938150
Name:WHEELS OF VISION, INC.
Entity Type:Organization
Organization Name:WHEELS OF VISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-739-6507
Mailing Address - Street 1:13809 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2641
Mailing Address - Country:US
Mailing Address - Phone:718-739-6507
Mailing Address - Fax:718-523-7466
Practice Address - Street 1:13809 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-2641
Practice Address - Country:US
Practice Address - Phone:718-739-6507
Practice Address - Fax:718-523-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004661332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00531228Medicaid
NY36046Medicare PIN
NY0323920001Medicare NSC