Healthcare Provider Details

I. General information

NPI: 1295081149
Provider Name (Legal Business Name): SIRGANY EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 STATE RTE 13
CORTLAND NY
13045
US

IV. Provider business mailing address

992 STATE ROUTE 13
CORTLAND NY
13045
US

V. Phone/Fax

Practice location:
  • Phone: 607-749-2020
  • Fax: 607-749-2220
Mailing address:
  • Phone: 607-749-2020
  • Fax: 607-749-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV 006874
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRIAN J SIRGANY
Title or Position: OWNER
Credential: OD
Phone: 607-749-2020