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General NPI Number Information
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NPI Number | 1225346018
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Entity Type | Organization
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Legal Business Name | COLUMBIA VISION CARE, OD, PC
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 389 FAIRVIEW AVE
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City | HUDSON
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State | NY
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Zip | 12534-1222
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Country | US
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Telephone | 518-822-9060
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Fax | 518-822-9062
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Provider Business Mailing Address
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Address Line | 389 FAIRVIEW AVE
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City | HUDSON
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State | NY
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Zip | 12534-1222
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Country | US
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Telephone | 518-822-9060
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Fax | 518-822-9062
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HEATHER M BROOKS
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Credential | OPTICIAN
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Telephone | 518-822-9060
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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 | TUV005879
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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 | 008662
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License Number State | NY
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