Healthcare Provider Details

I. General information

NPI: 1609055342
Provider Name (Legal Business Name): TWIN TIERS EYE CARE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E 4TH ST
WATKINS GLEN NY
14891-1217
US

IV. Provider business mailing address

207 MADISON AVE
ELMIRA NY
14901-3204
US

V. Phone/Fax

Practice location:
  • Phone: 607-535-4842
  • Fax: 607-398-3413
Mailing address:
  • Phone: 607-734-2984
  • Fax: 607-398-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS FRIEDRICH
Title or Position: ADMINISTRATOR
Credential:
Phone: 607-734-2984