Healthcare Provider Details

I. General information

NPI: 1548363930
Provider Name (Legal Business Name): AMIR MINASAZI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N CAROLINE ST
HERKIMER NY
13350-1716
US

IV. Provider business mailing address

103 N CAROLINE ST
HERKIMER NY
13350-1716
US

V. Phone/Fax

Practice location:
  • Phone: 315-717-0264
  • Fax: 315-717-0266
Mailing address:
  • Phone: 315-717-0264
  • Fax: 315-717-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberORT0068761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: