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General NPI Number Information
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NPI Number | 1598201824
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Entity Type | Organization
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Legal Business Name | GOVERNMENT EYE CARE
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 2264 SARANAC AVE
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City | LAKE PLACID
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State | NY
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Zip | 12946-3383
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Country | US
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Telephone | 518-302-5578
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Fax |
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Provider Business Mailing Address
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Address Line | 5160 KINLOCH CIR
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-9681
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. TYLER JOSEPH MAXON
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Credential | O.D.
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Telephone | 760-819-1141
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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 | TUV008307
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License Number State | NY
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