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General NPI Number Information
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NPI Number | 1972665701
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Entity Type | Organization
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Legal Business Name | COXSACKIE OPTOMETRIC PC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 10 A ELY ST
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City | COXSACKIE
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State | NY
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Zip | 12051-1216
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Country | US
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Telephone | 518-731-9405
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Fax |
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Provider Business Mailing Address
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Address Line | 83 MANSION ST
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City | COXSACKIE
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State | NY
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Zip | 12051-1216
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Country | US
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Telephone | 518-731-9405
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Fax |
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Authorized Official
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Title or Position | OWNER PARTNER
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Name | DR. DEBRA E HAMMERER
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Credential | OD
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Telephone | 518-731-9405
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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 | TUV0048681
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License Number State | NY
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