Provider Demographics
NPI:1891035150
Name:VISION CENTER OPTICAL INC
Entity Type:Organization
Organization Name:VISION CENTER OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-862-3937
Mailing Address - Street 1:2100 BARTOW AVE
Mailing Address - Street 2:SUITE 216C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4614
Mailing Address - Country:US
Mailing Address - Phone:718-862-3937
Mailing Address - Fax:
Practice Address - Street 1:2100 BARTOW AVE
Practice Address - Street 2:SUITE 216C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4614
Practice Address - Country:US
Practice Address - Phone:718-862-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226327156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty