Provider Demographics
NPI:1770755803
Name:EYECARE UNLIMITED, INC.
Entity type:Organization
Organization Name:EYECARE UNLIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-736-6161
Mailing Address - Street 1:1850 ROUTE 112
Mailing Address - Street 2:SUITE L
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2232
Mailing Address - Country:US
Mailing Address - Phone:631-736-6161
Mailing Address - Fax:631-736-1912
Practice Address - Street 1:1850 ROUTE 112
Practice Address - Street 2:SUITE L
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2232
Practice Address - Country:US
Practice Address - Phone:631-736-6161
Practice Address - Fax:631-736-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004022-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03082928Medicaid
NYU34063Medicare UPIN
NY03082928Medicaid