Provider Demographics
NPI:1477671337
Name:UMANSKY, VICTOR (OD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:UMANSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N GALLERIA DR
Mailing Address - Street 2:STE 126
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-3032
Mailing Address - Country:US
Mailing Address - Phone:845-692-5800
Mailing Address - Fax:845-692-5880
Practice Address - Street 1:1 N GALLERIA DR
Practice Address - Street 2:STE 126
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-3032
Practice Address - Country:US
Practice Address - Phone:845-692-5800
Practice Address - Fax:845-692-5880
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02742414Medicaid