Provider Demographics
NPI:1922217355
Name:METROPOLITAN VISION OPTOMETRY PLLC
Entity Type:Organization
Organization Name:METROPOLITAN VISION OPTOMETRY PLLC
Other - Org Name:FREDERIC K. NEVINS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-807-0019
Mailing Address - Street 1:22 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7902
Mailing Address - Country:US
Mailing Address - Phone:212-807-0019
Mailing Address - Fax:212-727-2395
Practice Address - Street 1:22 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7902
Practice Address - Country:US
Practice Address - Phone:212-807-0019
Practice Address - Fax:212-727-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006825-1152W00000X
NYTUV006641-1152W00000X
NYTUV003280-1152WC0802X
NYTUV006664-1152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU97137Medicare UPIN
NYT49156Medicare UPIN
NYU90393Medicare UPIN
NYU99106Medicare UPIN