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General NPI Number Information
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NPI Number | 1093150187
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Entity Type | Organization
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Legal Business Name | RHODY L SPOONER OPTICAL SERVICES
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 43744 STATE ROUTE 12
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City | ALEXANDRIA BAY
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State | NY
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Zip | 13607-2124
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Country | US
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Telephone | 315-482-0733
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Fax |
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Provider Business Mailing Address
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Address Line | 20140 CARR RD
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City | WELLESLEY ISLAND
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State | NY
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Zip | 13640-3186
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Country | US
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Telephone | 315-482-0733
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Fax |
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Authorized Official
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Title or Position | OPTICIAN/OWNER
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Name | MR. RHODY LEE SPOONER
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Credential |
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Telephone | 315-777-0682
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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 | TUV005520
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | C005466
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License Number State | NY
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