Provider Demographics
NPI:1518355767
Name:BRONX VISTASITE EYECARE
Entity Type:Organization
Organization Name:BRONX VISTASITE EYECARE
Other - Org Name:VISTASITE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-320-2222
Mailing Address - Street 1:200 BAYCHESTER AVE STE 212B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4583
Mailing Address - Country:US
Mailing Address - Phone:718-320-2222
Mailing Address - Fax:
Practice Address - Street 1:200 BAYCHESTER AVE STE 212B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4583
Practice Address - Country:US
Practice Address - Phone:718-320-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier