Provider Demographics
NPI:1770893729
Name:MORICHES VISION CENTER
Entity type:Organization
Organization Name:MORICHES VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:631-878-0606
Mailing Address - Street 1:225 MONTAUK HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955
Mailing Address - Country:US
Mailing Address - Phone:631-878-0606
Mailing Address - Fax:631-909-4325
Practice Address - Street 1:225 MONTAUK HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955
Practice Address - Country:US
Practice Address - Phone:631-878-0606
Practice Address - Fax:631-909-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8025-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty