Healthcare Provider Details

I. General information

NPI: 1336378587
Provider Name (Legal Business Name): NEW HARTFORD OPTOMETRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8374 SENECA TPKE
NEW HARTFORD NY
13413-4956
US

IV. Provider business mailing address

8374 SENECA TPKE
NEW HARTFORD NY
13413-4956
US

V. Phone/Fax

Practice location:
  • Phone: 315-797-9091
  • Fax:
Mailing address:
  • Phone: 315-797-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV 005040
License Number StateNY

VIII. Authorized Official

Name: MICHAEL WATERMAN
Title or Position: OWNER
Credential: OD
Phone: 315-797-9091