Healthcare Provider Details

I. General information

NPI: 1609369107
Provider Name (Legal Business Name): EYES ON MAIN ST. OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 07/22/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 STATE ROUTE 52
JEFFERSONVILLE NY
12748
US

IV. Provider business mailing address

PO BOX 67
JEFFERSONVILLE NY
12748-0067
US

V. Phone/Fax

Practice location:
  • Phone: 845-482-2425
  • Fax:
Mailing address:
  • Phone: 845-482-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008297
License Number StateNY

VIII. Authorized Official

Name: DR. MAEGAN SAUER
Title or Position: OPTOMETRIST
Credential: OD
Phone: 845-482-2425