Provider Demographics
NPI:1922066653
Name:OASIS VISION CENTER
Entity Type:Organization
Organization Name:OASIS VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAVROS
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLEGIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-921-4827
Mailing Address - Street 1:7411 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2713
Mailing Address - Country:US
Mailing Address - Phone:718-921-4827
Mailing Address - Fax:
Practice Address - Street 1:7411 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2713
Practice Address - Country:US
Practice Address - Phone:718-921-4827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01630111Medicaid
NY01630111Medicaid
0953820001Medicare NSC
NYU50503Medicare UPIN