Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 006037 | NY |
NPI | 1013187673 |
---|---|
Provider Name | Mr. Joseph Vishnevetsky |
First Address | Staten Island, NY 10304-2313 |
Second Address | Staten Island, NY 10304-2313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2008 |
Last Update Date | 10/03/2008 |