Organization Name: | PAK OPTICAL OF WATERTOWN INC |
NPI Number: | 1255404315 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN ANTHONY KENNEDY (PRESIDENT) |
Mailing Address: | 111 Main Street Ogdensburg |
State: | NY US |
Postal Code: | 136691116 |
Phone Number: | 3153937754 |
Fax Number: | 3157828863 |
NPI Enumeration Date: | 11/16/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | C4952 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |