| |
55 S. Fourth Ave., Mt. Vernon, NY 10550-3104 | |
(914) 664-4600 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 55 S. Fourth Ave., Mt. Vernon, New York |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1578773081 | NPI | - | NPPES |
02902789 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 002488 (New York) | Primary |
Mailing Address | Practice Location Address |
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55 S 4th Ave, Mt Vernon, NY 10550-3104 Ph: (914) 664-4600 | 55 S. Fourth Ave., Mt. Vernon, NY 10550-3104 Ph: (914) 664-4600 |