Provider Demographics
NPI:1013587880
Name:MDP OPTOMETRY PC
Entity Type:Organization
Organization Name:MDP OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PUPPARO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-752-7512
Mailing Address - Street 1:750 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6464
Mailing Address - Country:US
Mailing Address - Phone:510-545-2020
Mailing Address - Fax:
Practice Address - Street 1:750 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6464
Practice Address - Country:US
Practice Address - Phone:510-545-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty