Provider Demographics
NPI:1700011681
Name:ANCONA EYECARE INC
Entity Type:Organization
Organization Name:ANCONA EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANCONA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-422-7800
Mailing Address - Street 1:84 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1004
Mailing Address - Country:US
Mailing Address - Phone:718-422-7800
Mailing Address - Fax:718-422-7887
Practice Address - Street 1:84 FRONT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1004
Practice Address - Country:US
Practice Address - Phone:718-422-7800
Practice Address - Fax:718-422-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C38221Medicare PIN
NYU69619Medicare UPIN