Provider Demographics
NPI:1679588164
Name:VINCENT P BASILICE M D P C
Entity Type:Organization
Organization Name:VINCENT P BASILICE M D P C
Other - Org Name:THE OPHTHALMIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PRESCOTT
Authorized Official - Last Name:BASILICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-751-2020
Mailing Address - Street 1:3400 NESCONSET HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3327
Mailing Address - Country:US
Mailing Address - Phone:631-751-2020
Mailing Address - Fax:631-751-0048
Practice Address - Street 1:3400 NESCONSET HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3327
Practice Address - Country:US
Practice Address - Phone:631-751-2020
Practice Address - Fax:631-751-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005780-1152W00000X
NY4104152W00000X
NY127126207W00000X
NY187993207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00417469Medicaid
NY441181927OtherRAILROAD MEDICARE
NYB13675Medicare UPIN