Provider Demographics
NPI:1679668727
Name:VISION FOR LIFE CORP
Entity type:Organization
Organization Name:VISION FOR LIFE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:WIANECKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-789-6103
Mailing Address - Street 1:66 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2802
Mailing Address - Country:US
Mailing Address - Phone:631-789-6103
Mailing Address - Fax:631-789-6105
Practice Address - Street 1:66 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2802
Practice Address - Country:US
Practice Address - Phone:631-789-6103
Practice Address - Fax:631-789-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU92327Medicare UPIN
NYC220G1Medicare ID - Type Unspecified
NYA100062702Medicare PIN