1275720781 NPI number — OLD SARATOGA OPTOMETRY & OPHTHALMIC DISPENSING, PLLC

Table of content: (NPI 1275720781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275720781 NPI number — OLD SARATOGA OPTOMETRY & OPHTHALMIC DISPENSING, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLD SARATOGA OPTOMETRY & OPHTHALMIC DISPENSING, PLLC
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:
OLD SARATOGA EYECARE
Provider Other Organization Name Type Code:
3
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:
1275720781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 FERRY ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
SCHUYLERVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12871-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-695-3040
Provider Business Mailing Address Fax Number:
518-695-3150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 STATE ROUTE 29
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWICH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12834-6120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-692-2040
Provider Business Practice Location Address Fax Number:
518-692-2440
Provider Enumeration Date:
09/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
518-692-2040

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  005918 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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