MEDICARE: SAVEDOFF CICCONE & DAVIS, DOCTORS OF OPTOMETRY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV005682-1	NY
2	152W00000X	Optometrist	TUV3788-1	NY
3	152W00000X	Optometrist	T004912-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	31552A	OTHER	NY	GROUP PIN NUMBER

General Provider Information

NPI Number	:	1922198969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAVEDOFF CICCONE & DAVIS, DOCTORS OF OPTOMETRY, PC

Provider Business Mailing Address
First Line	:	60 PRESIDENTIAL PLAZA
Second Line	:	STE 104
City	:	SYRACUSE
State	:	NY
Zip	:	13202-2292
Country	:	US
Telephone Number	:	315-472-4594
Fax Number	:	315-422-3068

Provider Business Practice Location Address
First Line	:	60 PRESIDENTIAL PLAZA
Second Line	:	STE 104
City	:	SYRACUSE
State	:	NY
Zip	:	13202-2292
Country	:	US
Telephone Number	:	315-472-4594
Fax Number	:	315-422-3068

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES H FORDE
Credential	:	OD
Telephone Number	:	315-472-4594

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	12/05/2025

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