Provider Demographics
NPI:1073565362
Name:ALTMAN, JOEL D (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:C/O EMPIRE VISION CENTER, INC
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:325 STATE RD
Practice Address - Street 2:MASS OPTOMETRIC ASSOCIATES, P.C.
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-4313
Practice Address - Country:US
Practice Address - Phone:508-996-3364
Practice Address - Fax:508-994-7451
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300268Medicaid
MA0300268Medicaid
MAW17308Medicare ID - Type Unspecified