MEDICARE: EYE Q OF CNY LLC

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	008511	NY
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1679949879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE Q OF CNY LLC

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	:

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	:

Authorized Official
Title or Position	:	OFFICE MANNAGER/OPTICIAN
Name	:	DIANE ENGELL
Credential	:
Telephone Number	:	315-797-2020

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	12/03/2018

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