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NPI Code Detail

MEDICARE: DR. DONNA R KONICK O.D.

MEDICARE: DR. DONNA R KONICK 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
1152W00000XOptometristT004912-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17431754OTHERNYAETNA
2796636OTHERMVP
300168680OTHERNYBCBS
42566952OTHERUHC
5928789001OTHERNYHEALTH NOW

General Provider Information

NPI Number : 1902874217
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONNA R KONICK O.D.
Provider Business Mailing Address
First Line : 1045 JAMES ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13203-2730
Country : US
Telephone Number : 315-413-7692
Fax Number : 315-422-3068
Provider Business Practice Location Address
First Line : 1045 JAMES ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13203-2730
Country : US
Telephone Number : 315-413-7692
Fax Number : 315-422-3068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2006
Last Update Date : 10/13/2021

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