Healthcare Provider Details

I. General information

NPI: 1073681169
Provider Name (Legal Business Name): BAY OPTICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 BAY ST
GLENS FALLS NY
12801-2329
US

IV. Provider business mailing address

152 BAY ST
GLENS FALLS NY
12801-2329
US

V. Phone/Fax

Practice location:
  • Phone: 518-792-4140
  • Fax: 518-792-9008
Mailing address:
  • Phone: 518-792-4140
  • Fax: 518-792-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREN A BEAULIEU
Title or Position: C.E.O.
Credential: M.B.A
Phone: 518-792-1300