Provider Demographics
NPI:1841253614
Name:EMPIRE VISION CENTER INC
Entity type:Organization
Organization Name:EMPIRE VISION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-445-7466
Mailing Address - Street 1:159 EXPRESS STREET
Mailing Address - Street 2:DAVIS VISION
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2404
Mailing Address - Country:US
Mailing Address - Phone:516-827-6727
Mailing Address - Fax:516-733-5508
Practice Address - Street 1:6660 4TH SECTION RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2448
Practice Address - Country:US
Practice Address - Phone:585-637-3300
Practice Address - Fax:585-637-3439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPIRE VISION CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-11
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0505220054Medicare NSC