Provider Demographics
NPI:1689841470
Name:MY VISION CARE CORPATION
Entity Type:Organization
Organization Name:MY VISION CARE CORPATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:YONGHO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-944-9266
Mailing Address - Street 1:1580 LEMOINE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1580 LEMOINE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5621
Practice Address - Country:US
Practice Address - Phone:201-944-9266
Practice Address - Fax:201-944-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00516300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8326908Medicaid
NJ3876410001Medicare NSC