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General NPI Number Information
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NPI Number | 1407227044
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY OPHTHALMOLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 3 LYON PL SUITE 101
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City | OGDENSBURG
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State | NY
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Zip | 13669-2590
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Country | US
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Telephone | 315-393-3937
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Fax | 315-393-0591
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Provider Business Mailing Address
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Address Line | 3 LYON PL SUITE 101
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City | OGDENSBURG
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State | NY
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Zip | 13669-2590
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Country | US
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Telephone | 315-393-3937
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Fax | 315-393-0591
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENYS BEAUVAIS
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Credential | M.D.
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Telephone | 315-393-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | C7949-1
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License Number State | NY
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