Healthcare Provider Details

I. General information

NPI: 1972665701
Provider Name (Legal Business Name): COXSACKIE OPTOMETRIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 A ELY ST
COXSACKIE NY
12051-1216
US

IV. Provider business mailing address

83 MANSION ST
COXSACKIE NY
12051-1216
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-9405
  • Fax:
Mailing address:
  • Phone: 518-731-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV0048681
License Number StateNY

VIII. Authorized Official

Name: DR. DEBRA E HAMMERER
Title or Position: OWNER PARTNER
Credential: OD
Phone: 518-731-9405