MK Vision Center Staten Island LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MK VISION CENTER STATEN ISLAND LLC

Practice address

1803 Victory Blvd
Staten Island, NY 10314-3515

Phone

(845) 495-3658

NPI assigned

Feb 21, 2023

Last updated

Mar 7, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Ma

Title

Owner

Phone

(646) 203-8979

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tiffany Chen, OD

  • Optometrist
  • Staten Island, NY
  • NPI 1952080517
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1922706779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143515",
            "telephone_number": "845-495-3658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143515",
            "telephone_number": "845-495-3658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MK VISION CENTER STATEN ISLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-21",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "MA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-203-8979"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Mittentag, LMSW
• Yurina Miyamoto, MD
• Giselle J Mizhquiri
• Juan A Mizhquiri
• MK Star Inc
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• MLTK LLC (Shoprite Pharmacy of Hylan Blvd)
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• MMP RX, LLC (Procare Pharmacy)

• Optometrist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.