Healthcare Provider Details

I. General information

NPI: 1609857150
Provider Name (Legal Business Name): ALLEN F ZUCK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 NEW HARTFORD SHOPPING CTR
NEW HARTFORD NY
13413-2144
US

IV. Provider business mailing address

52 NEW HARTFORD SHOPPING CTR
NEW HARTFORD NY
13413-2144
US

V. Phone/Fax

Practice location:
  • Phone: 315-735-7590
  • Fax: 315-732-0769
Mailing address:
  • Phone: 315-735-7590
  • Fax: 315-732-0769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTU003939-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTU003939-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: