Provider Demographics
NPI:1710135637
Name:WESLEY EYE CARE ASSOCIATES OF OPTOMETRY PC
Entity Type:Organization
Organization Name:WESLEY EYE CARE ASSOCIATES OF OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARON
Authorized Official - Middle Name:TZVI
Authorized Official - Last Name:GOTTESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-362-2020
Mailing Address - Street 1:443 ROUTE 306
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WESLEY HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10952
Mailing Address - Country:US
Mailing Address - Phone:845-362-2020
Mailing Address - Fax:845-362-2073
Practice Address - Street 1:443 ROUTE 306
Practice Address - Street 2:SUITE 2
Practice Address - City:WESLEY HILLS
Practice Address - State:NY
Practice Address - Zip Code:10952
Practice Address - Country:US
Practice Address - Phone:845-362-2020
Practice Address - Fax:845-362-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06537152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100107089Medicare PIN