Provider Demographics
NPI:1588032098
Name:CITY VISION CARE LLC
Entity Type:Organization
Organization Name:CITY VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSHA
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-445-9566
Mailing Address - Street 1:171 W 73RD ST
Mailing Address - Street 2:4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 W 73RD ST
Practice Address - Street 2:4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2944
Practice Address - Country:US
Practice Address - Phone:917-445-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0005955T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty