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General NPI Number Information
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NPI Number | 1699983262
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Entity Type | Organization
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Legal Business Name | OPTIVISION
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 3662 THE PARK
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City | CORTLAND
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State | NY
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Zip | 13045-3324
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Country | US
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Telephone | 607-753-7514
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Fax | 607-753-7515
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Provider Business Mailing Address
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Address Line | 3662 THE PARK
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City | CORTLAND
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State | NY
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Zip | 13045-3324
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Country | US
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Telephone | 607-753-7514
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Fax | 607-753-7515
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Authorized Official
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Title or Position | OPTICIAN,OWNER
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Name | MR. KENNETH W MCNEIL
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Credential |
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Telephone | 607-753-7514
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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 | TUV005032
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 4079
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TUV005032
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4079
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License Number State | NY
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