Organization Name: | JEANETTE L. BERGSTROM DBA BURNT HILLS OPTICAL |
NPI Number: | 1184899783 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEANETTE L. BERGSTROM (OWNER) |
Mailing Address: | 793 State Route 50 Burnt Hills |
State: | NY US |
Postal Code: | 120279501 |
Phone Number: | 5183996130 |
Fax Number: | 5183994604 |
NPI Enumeration Date: | 04/24/2008 |
NPI Last Update Date: | 07/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |