Healthcare Provider Details

I. General information

NPI: 1164545174
Provider Name (Legal Business Name): THOMAS CHRISTIAN FOOTE OPHTHALMIC DISPENSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 OLD ORCHARD RD
ARCADE NY
14009
US

IV. Provider business mailing address

PO BOX 165
JAVA CENTER NY
14082-0165
US

V. Phone/Fax

Practice location:
  • Phone: 585-752-3838
  • Fax:
Mailing address:
  • Phone: 585-752-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number5313C
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number5313C
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: