NPIViewer - Provider NPI 1366403115

NPI:	1366403115
Name:	GENERAL VISION SERVICES
Entity type:	Organization
Organization Name:	GENERAL VISION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	CFO
Authorized Official - Prefix:	MRS
Authorized Official - First Name:	DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:	CETTINA
Authorized Official - Suffix:
Authorized Official - Credentials:	MD,OD
Authorized Official - Phone:	212-729-5300
Mailing Address - Street 1:	520 8TH AVE
Mailing Address - Street 2:	9TH FLOOR
Mailing Address - City:	NEW YORK
Mailing Address - State:	NY
Mailing Address - Zip Code:	10018-6507
Mailing Address - Country:	US
Mailing Address - Phone:	212-729-5300
Mailing Address - Fax:	212-729-5382
Practice Address - Street 1:	520 8TH AVE
Practice Address - Street 2:	9TH FLOOR
Practice Address - City:	NEW YORK
Practice Address - State:	NY
Practice Address - Zip Code:	10018-6507
Practice Address - Country:	US
Practice Address - Phone:	212-729-5300
Practice Address - Fax:	212-729-5382
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-03-31
Last Update Date:	2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization	Group
Yes	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Multi-Specialty

State	Identifier ID	ID Type
NY	02321039	Medicaid
NY	02324972	Medicaid
NY	0231108	Medicaid
NY	02321084	Medicaid
NY	02324812	Medicaid
NY	02325088	Medicaid
NY	02320932	Medicaid
NY	02324849	Medicaid
NY	02320905	Medicaid
NY	02325111	Medicaid
NY	02320643	Medicaid
NY	02324909	Medicaid
NY	02409281	Medicaid
NY	02320950	Medicaid
NY	02324990	Medicaid
NY	02320914	Medicaid
NY	02324936	Medicaid
NY	02324954	Medicaid
NY	02320818	Medicaid