1508900242 NPI number — DUTCHESS OPTOMETRY, LLP

Table of content: (NPI 1508900242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508900242 NPI number — DUTCHESS OPTOMETRY, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUTCHESS OPTOMETRY, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508900242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7381 S BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED HOOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12571-1745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-758-8818
Provider Business Mailing Address Fax Number:
845-758-9215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7381 S BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED HOOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12571-1745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-758-8818
Provider Business Practice Location Address Fax Number:
845-758-9215
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAYEA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER PARTNER
Authorized Official Telephone Number:
845-758-8818

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 903935 . This is a "BLOCK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C211C1 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C26381 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10032271 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 597054 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 939167 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 950427 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C93911 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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