Healthcare Provider Details

I. General information

NPI: 1619038577
Provider Name (Legal Business Name): THE OPTICAL BARR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MCLEAN RD
CORTLAND NY
13045-3509
US

IV. Provider business mailing address

201 MCLEAN RD
CORTLAND NY
13045-3509
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-9629
  • Fax: 607-753-9454
Mailing address:
  • Phone: 607-753-9629
  • Fax: 607-753-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNY2925
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberNY2925
License Number StateNY

VIII. Authorized Official

Name: DR. TYLER LYNN SECORD
Title or Position: OWNER
Credential: O.D.
Phone: 607-753-9629