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General NPI Number Information
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NPI Number | 1578613006
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Entity Type | Individual
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Provider Name | JOHN GADSBY BIRDSALL III OPHTHALMIC DISPENSER
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5811 COUNTY RT. 32
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City | NORWICH
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State | NY
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Zip | 13815
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Country | US
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Telephone | 607-336-2020
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Fax | 607-336-1003
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Provider Business Mailing Address
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Address Line | 10 VINE ST. PO BOX 28
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City | GILBERTSVILLE
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State | NY
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Zip | 13776
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Country | US
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Telephone | 607-783-2222
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Fax | 607-336-1003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 5008
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License Number State | NY
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