Provider Demographics
NPI:1043755671
Name:UPTOWN OPTOMETRY PLLC
Entity Type:Organization
Organization Name:UPTOWN OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-486-8989
Mailing Address - Street 1:2 MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2504
Mailing Address - Country:US
Mailing Address - Phone:518-486-8989
Mailing Address - Fax:518-486-8988
Practice Address - Street 1:2 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2504
Practice Address - Country:US
Practice Address - Phone:518-486-8989
Practice Address - Fax:518-486-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005420-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty