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General NPI Number Information
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NPI Number | 1609113976
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Entity Type | Organization
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Legal Business Name | WASHINGTONVILLE OPTOMETRY, PC
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 2877 ROUTE 94 FIELDSTONE SQUARE SUITE 2
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City | BLOOMING GROVE
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State | NY
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Zip | 10914-0418
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Country | US
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Telephone | 845-496-9999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 418
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City | BLOOMING GROVE
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State | NY
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Zip | 10914-0418
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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 | PRESIDENT
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Name | DR. JENNIFER BATTIATO
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Credential |
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Telephone | 845-496-9999
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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 | TUV5971
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License Number State | NY
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