Provider Demographics
NPI:1073615795
Name:FEDER, DORON (OD)
Entity Type:Individual
Prefix:DR
First Name:DORON
Middle Name:
Last Name:FEDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6559
Mailing Address - Country:US
Mailing Address - Phone:845-342-2020
Mailing Address - Fax:845-342-5934
Practice Address - Street 1:125 DOLSON AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6559
Practice Address - Country:US
Practice Address - Phone:845-342-2020
Practice Address - Fax:845-342-5934
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003866-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC32491Medicare UPIN