Provider Demographics
NPI:1831442995
Name:GREEN ACRES VISTASITE INC
Entity type:Organization
Organization Name:GREEN ACRES VISTASITE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-523-4295
Mailing Address - Street 1:1088 GREEN ACRES MALL # 118
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1535
Mailing Address - Country:US
Mailing Address - Phone:718-547-2020
Mailing Address - Fax:
Practice Address - Street 1:1088 GREEN ACRES MALL # 118
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1535
Practice Address - Country:US
Practice Address - Phone:516-568-2010
Practice Address - Fax:516-568-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006117-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty