Basic Information
| Provider Information | |||||||||
| NPI: | 1194051672 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EYECARE ADVANTAGE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EYECARE VISION SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1953 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH BALDWIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115102820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168646289 | ||||||||
| FaxNumber: | 6314993062 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 WHITE PLAINS RD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104732522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554233700 | ||||||||
| FaxNumber: | 6314993062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2009 | ||||||||
| LastUpdateDate: | 10/03/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ASHINOFF | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | HARRIS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8554233700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | 003162 | NY | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 152W00000X | T003162 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.