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General NPI Number Information
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NPI Number | 1831440957
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Entity Type | Organization
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Legal Business Name | AGAPE' EYE CARE OPTOMETRIST PLLC
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 3 HEMPHILL PL SUITE 114
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City | MALTA
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State | NY
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Zip | 12020-4419
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Country | US
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Telephone | 518-899-0003
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Fax | 518-899-0123
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Provider Business Mailing Address
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Address Line | 3 HEMPHILL PL SUITE 114
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City | MALTA
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State | NY
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Zip | 12020-4419
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Country | US
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Telephone | 518-899-0003
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Fax | 518-899-0123
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHLEEN MARY CROWE
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Credential | OD
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Telephone | 518-899-0003
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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 | 5427
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License Number State | NY
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