Organization
BUENA VISTA VISION CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS ALBERTO DE LA ROSA OD (PRESIDENT)
(212) 926-0336
Entity
Organization
Contact information
Practice address
3777 BROADWAY, NEW YORK, NY 10032-1541
(212) 926-0336
(212) 926-0212
Mailing address
3777 BROADWAY, NEW YORK, NY 10032-1541
(212) 926-0336
(212) 926-0212
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV005619
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02334141
—
NY
01
—
2129260336
VSP
NY
01
—
43658
DAVIS VISION
NY
01
—
919634
BLOCK VISION
NY
Enumeration date
11/14/2006
Last updated
10/27/2015
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