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General NPI Number Information
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NPI Number | 1508952540
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Entity Type | Organization
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Legal Business Name | CORTLAND OPHTHALMOLOGICAL CARE, PLLC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 1160 TOMPKINS ST
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City | CORTLAND
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State | NY
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Zip | 13045-3578
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Country | US
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Telephone | 607-753-7528
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Fax | 607-756-8163
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Provider Business Mailing Address
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Address Line | 1160 TOMPKINS ST
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City | CORTLAND
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State | NY
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Zip | 13045-3578
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Country | US
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Telephone | 607-753-7528
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Fax | 607-756-8163
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. KIMBERLY M STEVENS
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Credential |
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Telephone | 607-753-7528
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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 | 005836
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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 | 006144
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 226008
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License Number State | NY
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