| Manorville Eyecare Center | |
|
460 County Road 111 Unit 8 Manorville NY 11949-3375 | |
| (917) 602-4139 | |
| Not Available |
| Full Name | Manorville Eyecare Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 460 County Road 111 Unit 8, Manorville, New York |
| Authorized Official Name and Position | Peter Lacorte (OWNER) |
| Authorized Official Contact | 9176024139 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manorville Eyecare Center 199 Gothic Cir Manorville NY 11949-2622 Ph: (917) 602-4139 | Manorville Eyecare Center 460 County Road 111 Unit 8 Manorville NY 11949-3375 Ph: (917) 602-4139 |
| NPI Number | 1659849115 |
|---|---|
| Provider Enumeration Date | 11/02/2018 |
| Last Update Date | 11/02/2018 |
| Medicare PECOS PAC ID | 6002154341 |
|---|---|
| Medicare Enrollment ID | O20190213000381 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659849115 | NPI | - | NPPES |
| 11502510 | Other | NY | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (NU) | Primary |
| Provider Name | Peter J Lacorte |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1164569133 PECOS PAC ID: 0547355950 Enrollment ID: I20071001000283 |
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