Healthcare Provider Details

I. General information

NPI: 1740109206
Provider Name (Legal Business Name): REBECCA LYNNE BOORAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20823 NYS RT 3
WATERTOWN NY
13601-5821
US

IV. Provider business mailing address

20823 NYS RT 3
WATERTOWN NY
13601-5821
US

V. Phone/Fax

Practice location:
  • Phone: 315-788-1570
  • Fax: 315-788-0910
Mailing address:
  • Phone: 315-788-1570
  • Fax: 315-788-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number009684-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: