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General NPI Number Information
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NPI Number | 1932273026
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLEAR VISION CORP.
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 88 DUNNING RD STE 16
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2218
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Country | US
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Telephone | 845-692-5800
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Fax | 845-692-5880
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Provider Business Mailing Address
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Address Line | 88 DUNNING RD STE 16
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2218
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Country | US
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Telephone | 845-692-5800
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Fax | 845-692-5880
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Authorized Official
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Title or Position | ASSISTANT
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Name | MICHELLE ERICKSEN
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Credential |
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Telephone | 845-692-5800
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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 | 002805
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License Number State | NY
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