Provider Demographics
NPI:1568978773
Name:MERCEDES, VICTOR MANUEL
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:MERCEDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MAIN ST
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601
Mailing Address - Country:US
Mailing Address - Phone:914-285-1090
Mailing Address - Fax:914-285-1329
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-285-1090
Practice Address - Fax:914-285-1329
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009043156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician