Healthcare Provider Details

I. General information

NPI: 1427100486
Provider Name (Legal Business Name): CAROL ANN BALFE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 ERIE BLVD
CANAJOHARIE NY
13317-1133
US

IV. Provider business mailing address

410 WHITE RD
CANAJOHARIE NY
13317-3239
US

V. Phone/Fax

Practice location:
  • Phone: 518-673-2241
  • Fax:
Mailing address:
  • Phone: 518-673-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT-005534-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: