Provider Demographics
NPI:1659527596
Name:STONY BROOK VISION CARE INC
Entity Type:Organization
Organization Name:STONY BROOK VISION CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-751-6655
Mailing Address - Street 1:175 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2947
Mailing Address - Country:US
Mailing Address - Phone:631-751-6655
Mailing Address - Fax:631-751-6077
Practice Address - Street 1:175 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2947
Practice Address - Country:US
Practice Address - Phone:631-751-6655
Practice Address - Fax:631-751-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYU002724261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC4588-1Medicare PIN
NYU32249Medicare UPIN