Provider Demographics
NPI:1942620737
Name:VISION CENTER OF MEDFORD
Entity Type:Organization
Organization Name:VISION CENTER OF MEDFORD
Other - Org Name:VISION WORLD OF MEDFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFFEO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:631-775-9607
Mailing Address - Street 1:194 SHADYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4602
Mailing Address - Country:US
Mailing Address - Phone:631-807-1758
Mailing Address - Fax:631-775-9609
Practice Address - Street 1:700-20 PATCHOGUE YAPANK RD
Practice Address - Street 2:VISION CENTER OF MEDFORD D/B/A VISION WORLD OF MEDFORD
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763
Practice Address - Country:US
Practice Address - Phone:631-775-6907
Practice Address - Fax:631-775-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service