Provider Demographics
NPI:1720065014
Name:VISITING EYECARE SERVICE, INC.
Entity Type:Organization
Organization Name:VISITING EYECARE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FICHTENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:516-565-2616
Mailing Address - Street 1:320 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:W HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2043
Mailing Address - Country:US
Mailing Address - Phone:516-565-2616
Mailing Address - Fax:
Practice Address - Street 1:320 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:W HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2043
Practice Address - Country:US
Practice Address - Phone:516-565-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01561742Medicaid
NYC0W981Medicare ID - Type Unspecified