Provider Demographics
NPI:1659559862
Name:SUMMIT VISION CARE, INC.
Entity Type:Organization
Organization Name:SUMMIT VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORUR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-581-5100
Mailing Address - Street 1:150 ISLIP AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3222
Mailing Address - Country:US
Mailing Address - Phone:631-581-5100
Mailing Address - Fax:631-581-7512
Practice Address - Street 1:150 ISLIP AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3222
Practice Address - Country:US
Practice Address - Phone:631-581-5100
Practice Address - Fax:631-581-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004284152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00887274Medicaid
NYC40401Medicare PIN
NY00887274Medicaid
NYT8I499Medicare UPIN
NYA100051630Medicare PIN