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General NPI Number Information
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NPI Number | 1831918325
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Entity Type | Individual
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Provider Name | THERESA MARIE LEGAULT OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 7494 US HIGHWAY 11
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City | POTSDAM
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State | NY
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Zip | 13676-3577
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Country | US
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Telephone | 315-268-3921
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Fax | 315-268-6923
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Provider Business Mailing Address
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Address Line | 7494 US HIGHWAY 11
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City | POTSDAM
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State | NY
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Zip | 13676-3577
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Country | US
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Telephone | 315-268-6921
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Fax | 315-268-6923
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | C006845-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 6845
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License Number State | NY
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