Healthcare Provider Details

I. General information

NPI: 1407204761
Provider Name (Legal Business Name): ONEIDA OPTOMETRIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 MAIN ST
ONEIDA NY
13421-2452
US

IV. Provider business mailing address

581 MAIN ST
ONEIDA NY
13421-2452
US

V. Phone/Fax

Practice location:
  • Phone: 315-363-6210
  • Fax: 315-361-4942
Mailing address:
  • Phone: 315-363-6210
  • Fax: 315-361-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. JUSTIN A SMITH
Title or Position: SOLE OWNER
Credential: OD
Phone: 315-363-6210