| |
43744 State Route 12, Alexandria Bay, NY 13607-2124 | |
(315) 482-0733 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Technician/technologist - Optician |
Location | 43744 State Route 12, Alexandria Bay, New York |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1093150187 | NPI | - | NPPES |
03292422 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | TUV005520 (New York) | Secondary |
156FX1800X | Technician/technologist - Optician | C005466 (New York) | Primary |
Mailing Address | Practice Location Address |
---|---|
20140 Carr Rd, Wellesley Island, NY 13640-3186 Ph: (315) 482-0733 | 43744 State Route 12, Alexandria Bay, NY 13607-2124 Ph: (315) 482-0733 |