Provider Demographics
NPI:1568605814
Name:GRACE EYECARE
Entity Type:Organization
Organization Name:GRACE EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WIDAD
Authorized Official - Middle Name:ARTAGRACE
Authorized Official - Last Name:VALME
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-826-2020
Mailing Address - Street 1:1615 CORTELYOU RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5209
Mailing Address - Country:US
Mailing Address - Phone:718-826-2020
Mailing Address - Fax:
Practice Address - Street 1:1615 CORTELYOU RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5209
Practice Address - Country:US
Practice Address - Phone:718-826-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006890152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC478C1OtherEMPIRE BLUE CROSS BLUE SHIELD
NYP3686293OtherOXFORD
NYC478C1OtherEMPIRE BLUE CROSS BLUE SHIELD
NYP3686293OtherOXFORD