Provider Demographics
NPI:1972756625
Name:WHITE PLAINS VISION CARE INC,
Entity Type:Organization
Organization Name:WHITE PLAINS VISION CARE INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLO RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:ABOM
Authorized Official - Phone:914-949-8000
Mailing Address - Street 1:148 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5301
Mailing Address - Country:US
Mailing Address - Phone:914-949-8000
Mailing Address - Fax:914-286-3042
Practice Address - Street 1:148 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5301
Practice Address - Country:US
Practice Address - Phone:914-949-8000
Practice Address - Fax:914-286-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004032-1156FC0801X, 156FX1800X, 246Z00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty