Provider Demographics
NPI:1083044143
Name:HUDSON VALLEY EYE DOCTOR OF OPTOMETRY PC
Entity Type:Organization
Organization Name:HUDSON VALLEY EYE DOCTOR OF OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-565-2020
Mailing Address - Street 1:304 FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3722
Mailing Address - Country:US
Mailing Address - Phone:845-565-2020
Mailing Address - Fax:
Practice Address - Street 1:304 FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3722
Practice Address - Country:US
Practice Address - Phone:845-565-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty