MEDICARE: JOSEPH A CARROCK OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV005308	NY

General Provider Information

NPI Number	:	1003972399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH A CARROCK OD

Provider Business Mailing Address
First Line	:	4660 COMMERCIAL DR
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-6203
Country	:	US
Telephone Number	:	315-797-2020
Fax Number	:	315-736-2472

Provider Business Practice Location Address
First Line	:	4660 COMMERCIAL DR
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-6203
Country	:	US
Telephone Number	:	315-797-2020
Fax Number	:	315-736-2472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	10/14/2015

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