Provider Demographics
NPI:1538691720
Name:OPHTHALMOLOGY SPECIALISTS OF NEW YORK LLC
Entity Type:Organization
Organization Name:OPHTHALMOLOGY SPECIALISTS OF NEW YORK LLC
Other - Org Name:VISTA EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-801-1847
Mailing Address - Street 1:10005 ROOSEVELT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4880
Mailing Address - Country:US
Mailing Address - Phone:917-832-7557
Mailing Address - Fax:917-832-7503
Practice Address - Street 1:10005 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4880
Practice Address - Country:US
Practice Address - Phone:787-366-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery