Provider Demographics
NPI:1841509189
Name:OAKDALE VISION CENTER, INC.
Entity type:Organization
Organization Name:OAKDALE VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-689-7607
Mailing Address - Street 1:22 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3104
Mailing Address - Country:US
Mailing Address - Phone:631-689-7607
Mailing Address - Fax:631-218-0919
Practice Address - Street 1:22 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-3104
Practice Address - Country:US
Practice Address - Phone:631-689-7607
Practice Address - Fax:631-218-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100038359Medicare PIN