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General NPI Number Information
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NPI Number | 1801229620
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Entity Type | Organization
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Legal Business Name | DRYDEN OPTOMETRY P.C.
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 88 NORTH ST
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City | DRYDEN
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State | NY
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Zip | 13053-8500
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Country | US
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Telephone | 607-844-9477
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Fax | 607-844-9478
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Provider Business Mailing Address
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Address Line | 88 NORTH ST
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City | DRYDEN
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State | NY
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Zip | 13053-8500
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Country | US
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Telephone | 607-844-9477
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Fax | 607-844-9478
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MELISSA CLARE OLTZ
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Credential | O.D.
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Telephone | 607-351-2668
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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 | 007205
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License Number State | NY
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