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General NPI Number Information
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NPI Number | 1275600496
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Entity Type | Organization
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Legal Business Name | PENN YAN OPTOMETRY PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 163 MAIN ST
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City | PENN YAN
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State | NY
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Zip | 14527-1284
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Country | US
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Telephone | 315-536-9941
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Fax | 315-536-9321
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Provider Business Mailing Address
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Address Line | 163 MAIN ST
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City | PENN YAN
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State | NY
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Zip | 14527-1284
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Country | US
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Telephone | 315-536-9941
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Fax | 315-536-9321
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ANDREW PAUL SMITH
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Credential | O.D.
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Telephone | 315-536-9941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | TUV005146-J
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV005146-J
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TUV005146-J
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License Number State | NY
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