Healthcare Provider Details

I. General information

NPI: 1225942014
Provider Name (Legal Business Name): SQUARE DEAL OPTICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 COURT ST
BINGHAMTON NY
13901-3101
US

IV. Provider business mailing address

52 FOWLER AVE
JOHNSON CITY NY
13790-2910
US

V. Phone/Fax

Practice location:
  • Phone: 607-743-8039
  • Fax: 607-724-2222
Mailing address:
  • Phone: 607-427-2735
  • Fax: 607-724-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTOPHER JOSEPH WELCH
Title or Position: OPTICIAN
Credential:
Phone: 607-427-2735