Provider Demographics
NPI:1043268733
Name:FIRSTVIEW EYE CARE DOCTOR OF OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:FIRSTVIEW EYE CARE DOCTOR OF OPTOMETRY, PLLC
Other - Org Name:CHARLES W PAEPKE OD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAEPKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-563-5460
Mailing Address - Street 1:202 WEST BAY PLAZA
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1786
Mailing Address - Country:US
Mailing Address - Phone:518-563-5460
Mailing Address - Fax:888-244-5003
Practice Address - Street 1:202 WEST BAY PLAZA
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1786
Practice Address - Country:US
Practice Address - Phone:518-563-5460
Practice Address - Fax:888-244-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003778-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY415801001OtherBLSHD NE NY
NY415801001OtherBLSHD NE NY
NY0157830001Medicare NSC
NMBA0136Medicare ID - Type Unspecified