Provider Demographics
NPI:1093150187
Name:RHODY L SPOONER OPTICAL SERVICES
Entity Type:Organization
Organization Name:RHODY L SPOONER OPTICAL SERVICES
Other - Org Name:1000 EYE LANDS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RHODY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-777-0682
Mailing Address - Street 1:20140 CARR RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13640-3186
Mailing Address - Country:US
Mailing Address - Phone:315-482-0733
Mailing Address - Fax:
Practice Address - Street 1:43744 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA BAY
Practice Address - State:NY
Practice Address - Zip Code:13607-2124
Practice Address - Country:US
Practice Address - Phone:315-482-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005520152W00000X
NYC005466156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03292422Medicaid