Provider Demographics
NPI:1770760308
Name:MT PLEASANT VISION CENTER, INC
Entity type:Organization
Organization Name:MT PLEASANT VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:914-747-2000
Mailing Address - Street 1:660 COLUMBUS AVE
Mailing Address - Street 2:3-3
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594-1909
Mailing Address - Country:US
Mailing Address - Phone:914-747-2000
Mailing Address - Fax:914-747-4032
Practice Address - Street 1:660 COLUMBUS AVE
Practice Address - Street 2:3-3
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-1909
Practice Address - Country:US
Practice Address - Phone:914-747-2000
Practice Address - Fax:914-747-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5840332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC244D1OtherEMPIRE BLUE CROSS BLUE SHIELD
NY6501628OtherGHI
NYP2496215OtherOXFORD HEALTH PLANS
NY=========OtherPOMCO
NY6501628OtherGHI
NY=========OtherPOMCO
NY6501628OtherGHI
NY1770760308Medicare NSC