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General NPI Number Information
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NPI Number | 1619030376
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Entity Type | Individual
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Provider Name | PRABHJPT KAUR MCTAGUE O.D
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Gender | Female
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Dates
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Enumeration Date | 12/17/2006
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 1294 UPPER LENOX AVE
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City | ONEIDA
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State | NY
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Zip | 13421-2681
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Country | US
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Telephone | 315-361-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 5013 YELLOW WOOD PKWY
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City | JAMESVILLE
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State | NY
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Zip | 13078-8521
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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 |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV006706-1
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License Number State | NY
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