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Provider Information for 1679588164

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

VINCENT P BASILICE M D P C

Other Name:   Doing Business As: THE OPHTHALMIC CENTER
Organization Subpart: NO

Organization NPI: 1679588164

Calendar   Last Updated:  2020-10-07
  Certification Date:  2020-10-07

Details

Name Value
NPI 1679588164
Enumeration Date 2006-07-31
NPI Type 2- Organization
Status Active
Authorized Official Information Name: VINCENT PRESCOTT BASILICE MD
Title: MEDICAL DIRECTOR/ PRESIDENT
Phone: 631-751-2020
Mailing Address 3400 NESCONSET HWY SUITE 107
EAST SETAUKET, NY 11733-3327
United States

Phone: 631-751-2020 | Fax: 631-751-0048
View Map External Link
Primary Practice Address 3400 NESCONSET HWY SUITE 107
EAST SETAUKET, NY 11733-3327
United States

Phone: 631-751-2020 | Fax: 631-751-0048
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other RAILROAD MEDICARE NY 441181927
MEDICAID NY 00417469
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193200000X MULTI-SPECIALTY GROUP
207W00000X - Ophthalmology
NY 127126
No 193200000X MULTI-SPECIALTY GROUP
152W00000X - Optometrist
NY 4104
No 193200000X MULTI-SPECIALTY GROUP
152W00000X - Optometrist
NY TUV005780-1
No 193200000X MULTI-SPECIALTY GROUP
207W00000X - Ophthalmology
NY 187993