| |
12 Main St, Potsdam, NY 13676-2007 | |
(315) 261-4287 | |
(315) 261-4319 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 12 Main St, Potsdam, New York |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1316289960 | NPI | - | NPPES |
03424311 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
1815 State St, Watertown, NY 13601-9406 Ph: (315) 788-6070 | 12 Main St, Potsdam, NY 13676-2007 Ph: (315) 261-4287 |