Healthcare Provider Details

I. General information

NPI: 1770783367
Provider Name (Legal Business Name): COXSAKIE OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11877 RT 9W SUITE 2
WEST COXSACKIE NY
12192-1302
US

IV. Provider business mailing address

11877 RT 9W SUITE 2
WEST COXSACKIE NY
12192-1302
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-7803
  • Fax:
Mailing address:
  • Phone: 518-731-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number4744
License Number StateNY

VIII. Authorized Official

Name: ANTHONY CORNELL
Title or Position: OWNER
Credential:
Phone: 518-731-7803