Provider Demographics
NPI:1578583415
Name:PRIMARY VISION CARE 1, LLC
Entity Type:Organization
Organization Name:PRIMARY VISION CARE 1, LLC
Other - Org Name:PRIMARY VISION CARE I, L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-299-3456
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-0961
Mailing Address - Country:US
Mailing Address - Phone:718-299-3456
Mailing Address - Fax:718-299-1040
Practice Address - Street 1:1236 CASTLE HILL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4805
Practice Address - Country:US
Practice Address - Phone:718-299-3456
Practice Address - Fax:718-299-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005576-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01893205Medicaid
NYU51519Medicare UPIN
NY01893205Medicaid
NYC58981Medicare ID - Type Unspecified