Healthcare Provider Details

I. General information

NPI: 1447230867
Provider Name (Legal Business Name): SOUTHERN TIER OPTOMETRIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CENTER ST
HORNELL NY
14843-1931
US

IV. Provider business mailing address

55 CENTER ST
HORNELL NY
14843-1931
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-7710
  • Fax:
Mailing address:
  • Phone: 607-324-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAM L ROSENSWIE
Title or Position: CORPORATE BUSINESS MANAGER
Credential:
Phone: 716-372-9464