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General NPI Number Information
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NPI Number | 1780194407
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Entity Type | Organization
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Legal Business Name | COHOES EYE ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/08/2017
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 91 MOHAWK ST
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City | COHOES
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State | NY
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Zip | 12047-2809
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Country | US
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Telephone | 518-237-0342
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Fax | 518-235-9266
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Provider Business Mailing Address
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Address Line | 91 MOHAWK ST
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City | COHOES
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State | NY
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Zip | 12047
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Country | US
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Telephone | 518-237-0342
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Fax | 518-235-9266
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KELLY PRIMEAU
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Credential | OD
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Telephone | 518-233-0463
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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 | TUV005872
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License Number State | NY
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