Healthcare Provider Details

I. General information

NPI: 1649491994
Provider Name (Legal Business Name): BETSY UTNICK NYS LIC. OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 STATE ROUTE 17M PLAZA OPTICAL
MONROE NY
10950-4169
US

IV. Provider business mailing address

7 CHIMNEY RIDGE DR
HARRIMAN NY
10926-3617
US

V. Phone/Fax

Practice location:
  • Phone: 845-783-4400
  • Fax: 845-782-4041
Mailing address:
  • Phone: 845-783-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberC005082-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC50082-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: