Healthcare Provider Details

I. General information

NPI: 1629124649
Provider Name (Legal Business Name): TRI-COUNTY EYE CARE AND OPTOMETRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3685 BURGOYNE AVE
HUDSON FALLS NY
12839-2168
US

IV. Provider business mailing address

3685 BURGOYNE AVE
HUDSON FALLS NY
12839-2168
US

V. Phone/Fax

Practice location:
  • Phone: 518-747-4100
  • Fax: 518-747-6151
Mailing address:
  • Phone: 518-747-4100
  • Fax: 518-747-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV006839-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberTUV006839-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTUV006839-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier782077
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMVP
# 2
Identifier10089360
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerCDPHP
# 3
Identifier000408532001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBSNENY
# 4
IdentifierC369F1
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerEMPIRE

VIII. Authorized Official

Name: MONICA REDMOND
Title or Position: OPTOMETRIST
Credential: OD
Phone: 518-747-4100