MEDICARE: DR. AUGUST PATRICK SINICROPI O.D.

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	TUV003041-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P010003041	OTHER	NY	EXCELLUS

General Provider Information

NPI Number	:	1780620948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUGUST PATRICK SINICROPI O.D.

Provider Business Mailing Address
First Line	:	122 E BAYARD ST
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148-1640
Country	:	US
Telephone Number	:	315-568-6991
Fax Number	:	315-568-8454

Provider Business Practice Location Address
First Line	:	122 E BAYARD ST
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148-1640
Country	:	US
Telephone Number	:	315-568-6991
Fax Number	:	315-568-8454

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/03/2015

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