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General NPI Number Information
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NPI Number | 1619317245
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Entity Type | Organization
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Legal Business Name | BAY OPTICAL, INC
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 3695 MAIN ST
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City | WARRENSBURG
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State | NY
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Zip | 12885-1832
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Country | US
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Telephone | 518-623-2229
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Fax | 518-623-5087
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Provider Business Mailing Address
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Address Line | 3695 MAIN ST
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City | WARRENSBURG
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State | NY
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Zip | 12885-1832
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Country | US
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Telephone | 518-623-2229
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Fax | 518-623-5087
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Authorized Official
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Title or Position | C.E.O.
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Name | MRS. LAUREN A BEAULIEU
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Credential | M.B.A.
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Telephone | 518-792-1300
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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 | 0042381
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License Number State | NY
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