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General NPI Number Information
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NPI Number | 1639396856
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL OPTOMETRY DOWNTOWN, PC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 65 WOLF RD STE 106
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City | ALBANY
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State | NY
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Zip | 12205-2621
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Country | US
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Telephone | 518-463-1707
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Fax | 518-949-2499
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Provider Business Mailing Address
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Address Line | 65 WOLF RD STE 106
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City | ALBANY
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State | NY
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Zip | 12205-2621
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Country | US
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Telephone | 518-463-1707
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Fax | 518-949-2499
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELISA PERREAULT
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Credential | OPTOMETRIST
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Telephone | 518-463-1707
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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 | TUV005329
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License Number State | NY
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