Healthcare Provider Details

I. General information

NPI: 1124541370
Provider Name (Legal Business Name): OSSINING FAMILY OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 CROTON AVE # 3
OSSINING NY
10562-4981
US

IV. Provider business mailing address

57 CROTON AVE # 3
OSSINING NY
10562-4981
US

V. Phone/Fax

Practice location:
  • Phone: 914-923-0300
  • Fax: 914-923-0450
Mailing address:
  • Phone: 914-923-0300
  • Fax: 914-923-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007907
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTUV007907
License Number StateNY

VIII. Authorized Official

Name: DR. BRIAN M RODRIGUES
Title or Position: OPTOMETRIST
Credential: OD
Phone: 914-923-0300