Healthcare Provider Details

I. General information

NPI: 1750345435
Provider Name (Legal Business Name): MARILYN RENEE FORAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILYN RENEE BIELINSKI OD

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 E MAIN ST
ENDICOTT NY
13760-5531
US

IV. Provider business mailing address

207 MADISON AVE
ELMIRA NY
14901-3204
US

V. Phone/Fax

Practice location:
  • Phone: 607-748-3434
  • Fax: 607-398-3408
Mailing address:
  • Phone: 607-734-2984
  • Fax: 607-398-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV0053061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: