MEDICARE: TOWN & COUNTRY OPTICAL,INC.

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	332H00000X	Eyewear Supplier	005800	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C9W05	OTHER	NY	EMPIRE BLUE CROSS

General Provider Information

NPI Number	:	1639228729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN & COUNTRY OPTICAL,INC.

Provider Business Mailing Address
First Line	:	535 BAY RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-3018
Country	:	US
Telephone Number	:	518-793-5395
Fax Number	:	518-793-5543

Provider Business Practice Location Address
First Line	:	535 BAY RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-3018
Country	:	US
Telephone Number	:	518-793-5395
Fax Number	:	518-793-5543

Authorized Official
Title or Position	:	OPTICIAN-MANAGER
Name	:	MS. KATHLEEN A LARROW
Credential	:
Telephone Number	:	518-793-5395

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	08/22/2020

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Directions to “TOWN & COUNTRY OPTICAL,INC. ” Practice Location

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