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General NPI Number Information
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NPI Number | 1801234083
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Entity Type | Organization
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Legal Business Name | EHSOC
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 19316 US ROUTE 11 BLDG 4 STE A
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City | WATERTOWN
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State | NY
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Zip | 13601-5337
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Country | US
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Telephone | 315-804-6966
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Fax | 315-661-6870
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Provider Business Mailing Address
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Address Line | 19316 US ROUTE 11 BLDG 4 STE A
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City | WATERTOWN
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State | NY
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Zip | 13601-5337
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Country | US
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Telephone | 315-804-6966
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Fax | 315-661-6870
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Authorized Official
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Title or Position | COOWNER/OPTOMETRIST
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Name | BRUCE ARTHUR LEVINSON
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Credential | O.D.
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Telephone | 315-455-8933
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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 | 007004
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T005365
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License Number State | NY
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