Organization
EYESITE VISION III INCORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLEMENT E IDEHEN O.D (OWNER)
(917) 650-0190
Entity
Organization
Contact information
Practice address
446 KNICKERBOCKER AVE, BROOKLYN, NY 11237-4509
(718) 455-6500
(718) 455-6507
Mailing address
248 KENSINGTON, LYNBROOK, LONG ISLAND, NY 11563-2711
(917) 650-0190
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
VUT006065
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02705526
—
NY
Enumeration date
06/26/2006
Last updated
04/13/2017
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