Healthcare Provider Details

I. General information

NPI: 1972916096
Provider Name (Legal Business Name): DAVID M. GIRARDI, OD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 FRANKLIN PARK DR
EAST SYRACUSE NY
13057-1614
US

IV. Provider business mailing address

824 FRANKLIN PARK DR
EAST SYRACUSE NY
13057-1614
US

V. Phone/Fax

Practice location:
  • Phone: 315-446-1288
  • Fax: 315-446-2210
Mailing address:
  • Phone: 315-446-1288
  • Fax: 315-446-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005152
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID M GIRARDI
Title or Position: PRESIDENT
Credential: OD
Phone: 315-446-1288