Healthcare Provider Details

I. General information

NPI: 1497048821
Provider Name (Legal Business Name): MR. MICHAEL THOMAS HUTCHINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 S SALINA ST
SYRACUSE NY
13202-3527
US

IV. Provider business mailing address

819 S SALINA ST
SYRACUSE NY
13202-3527
US

V. Phone/Fax

Practice location:
  • Phone: 315-299-4074
  • Fax:
Mailing address:
  • Phone: 315-299-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number008235-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: