Provider Demographics
NPI:1073921870
Name:ITHACA EYE CARE OPTOMETRY PLLC
Entity Type:Organization
Organization Name:ITHACA EYE CARE OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KLINGAMAN
Authorized Official - Last Name:BOSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-613-9080
Mailing Address - Street 1:312 SIENA DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1753
Mailing Address - Country:US
Mailing Address - Phone:610-613-9080
Mailing Address - Fax:
Practice Address - Street 1:414 E UPLAND RD
Practice Address - Street 2:SUITE A
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2527
Practice Address - Country:US
Practice Address - Phone:610-613-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007237-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty