Healthcare Provider Details

I. General information

NPI: 1215036405
Provider Name (Legal Business Name): ADIRONDACK EYECARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HEADWATERS PLZ
BOONVILLE NY
13309-1300
US

IV. Provider business mailing address

6 HEADWATERS PLZ
BOONVILLE NY
13309-1300
US

V. Phone/Fax

Practice location:
  • Phone: 315-942-2122
  • Fax: 315-942-2084
Mailing address:
  • Phone: 315-942-2122
  • Fax: 315-942-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006918
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID JOHN VINCI
Title or Position: OPTOMETRIST
Credential: OD
Phone: 315-942-2122