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General NPI Number Information
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NPI Number | 1821087248
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Entity Type | Organization
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Legal Business Name | JAMESTOWN OPTOMETRIC GROUP, PC
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 555 FAIRMOUNT AVE
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City | JAMESTOWN
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State | NY
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Zip | 14701-2750
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Country | US
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Telephone | 716-664-7601
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Fax | 716-664-3353
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Provider Business Mailing Address
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Address Line | 555 FAIRMOUNT AVE
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City | JAMESTOWN
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State | NY
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Zip | 14701-2750
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Country | US
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Telephone | 716-664-7601
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Fax | 716-664-3353
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Authorized Official
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Title or Position | PARTNER
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Name | DR. CHRISTOPHER J COLBURN
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Credential | O.D.
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Telephone | 716-664-7601
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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 | TUV003318-1
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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 | TUV005272-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV006073-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1750
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV003267-1
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License Number State | NY
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