Provider Demographics
NPI:1104039304
Name:CLIFTON PARK EYE CARE OPTOMETRIC ASSOCIATES PLLC
Entity Type:Organization
Organization Name:CLIFTON PARK EYE CARE OPTOMETRIC ASSOCIATES PLLC
Other - Org Name:CLIFTON PARK EYE CARE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-371-3353
Mailing Address - Street 1:1618 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4304
Mailing Address - Country:US
Mailing Address - Phone:518-371-3353
Mailing Address - Fax:
Practice Address - Street 1:1618 ROUTE 9
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4304
Practice Address - Country:US
Practice Address - Phone:518-371-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005180332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier