Healthcare Provider Details

I. General information

NPI: 1144315409
Provider Name (Legal Business Name): LOGAN OPTICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E WASHINGTON ST
SYRACUSE NY
13202-1618
US

IV. Provider business mailing address

116 E WASHINGTON ST
SYRACUSE NY
13202-1618
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-3937
  • Fax: 315-472-2692
Mailing address:
  • Phone: 315-478-3937
  • Fax: 315-472-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV003556
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberC003601-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC003601-1
License Number StateNY

VIII. Authorized Official

Name: MR. LOUIS JOSEPH ENZERILLO
Title or Position: PRESIDENT
Credential:
Phone: 315-478-3937