MEDICARE: CAMELOT OPTICAL CORP

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	332BC3200X	Customized Equipment (DME)	1287091	NY

General Provider Information

NPI Number	:	1508957341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMELOT OPTICAL CORP

Provider Business Mailing Address
First Line	:	4350 MIDDLE SETTLEMENT RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-5316
Country	:	US
Telephone Number	:	315-732-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 MIDDLE SETTLEMENT RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-5316
Country	:	US
Telephone Number	:	315-732-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY J PALUMBO IV
Credential	:	M.D.
Telephone Number	:	315-732-2020

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	04/10/2008

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