Provider Demographics
NPI:1164545174
Name:FOOTE, THOMAS CHRISTIAN (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHRISTIAN
Last Name:FOOTE
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:JAVA CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14082-0165
Mailing Address - Country:US
Mailing Address - Phone:585-752-3838
Mailing Address - Fax:
Practice Address - Street 1:95 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:ARCADE
Practice Address - State:NY
Practice Address - Zip Code:14009
Practice Address - Country:US
Practice Address - Phone:585-752-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5313C156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter