Healthcare Provider Details

I. General information

NPI: 1447391933
Provider Name (Legal Business Name): OCUTIQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 UNIVERSITY AVE
SYRACUSE NY
13210-1807
US

IV. Provider business mailing address

612 UNIVERSITY AVE
SYRACUSE NY
13210-1807
US

V. Phone/Fax

Practice location:
  • Phone: 315-475-0186
  • Fax: 315-422-7339
Mailing address:
  • Phone: 315-475-0186
  • Fax: 315-422-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN HOEPNER
Title or Position: OWNER
Credential:
Phone: 315-475-0186