Provider Demographics
NPI:1154482198
Name:CENTRAL NEW YORK OPTOMETRY PLLC
Entity Type:Organization
Organization Name:CENTRAL NEW YORK OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LAMBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-725-3937
Mailing Address - Street 1:52 NEW HARTFORD SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2144
Mailing Address - Country:US
Mailing Address - Phone:315-735-7590
Mailing Address - Fax:
Practice Address - Street 1:52 NEW HARTFORD SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2144
Practice Address - Country:US
Practice Address - Phone:315-735-7590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005516-4152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01540454Medicaid
NYU45819Medicare UPIN
NY56972BMedicare ID - Type Unspecified