Provider Demographics
NPI:1134892763
Name:LONG ISLAND VISION AND CONTACT LENS SERVICES, INC.
Entity type:Organization
Organization Name:LONG ISLAND VISION AND CONTACT LENS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VACCARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-714-3030
Mailing Address - Street 1:160 WALT WHITMAN RD STE 1021B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4160
Mailing Address - Country:US
Mailing Address - Phone:631-714-6030
Mailing Address - Fax:
Practice Address - Street 1:160 WALT WHITMAN RD STE 1021B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4160
Practice Address - Country:US
Practice Address - Phone:631-714-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty