MEDICARE: SAMPSON 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	332H00000X	Eyewear Supplier	3786	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0845600002	OTHER	NY	DME

General Provider Information

NPI Number	:	1659541498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMPSON OPTICAL CORP

Provider Business Mailing Address
First Line	:	619 AVIATION RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-1842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 AVIATION RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-1842
Country	:	US
Telephone Number	:	518-798-6923
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE SAMPSON
Credential	:
Telephone Number	:	518-798-6923

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/10/2008

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Directions to “SAMPSON OPTICAL CORP ” Practice Location

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