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General NPI Number Information
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NPI Number | 1073921870
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Entity Type | Organization
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Legal Business Name | ITHACA EYE CARE OPTOMETRY PLLC
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 414 E UPLAND RD SUITE A
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City | ITHACA
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State | NY
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Zip | 14850-2527
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Country | US
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Telephone | 610-613-9080
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Fax |
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Provider Business Mailing Address
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Address Line | 312 SIENA DR
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City | ITHACA
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State | NY
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Zip | 14850-1753
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Country | US
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Telephone | 610-613-9080
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. AMY KLINGAMAN BOSCIA
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Credential | O.D.
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Telephone | 610-613-9080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV007237-1
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License Number State | NY
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