Provider Demographics
NPI:1174039937
Name:BALDASSARI, VICTOR ARTHUR (OPHTHALMIC /DISPENSE)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ARTHUR
Last Name:BALDASSARI
Suffix:
Gender:M
Credentials:OPHTHALMIC /DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MERCHANT PLACE
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-5715
Mailing Address - Country:US
Mailing Address - Phone:518-234-1155
Mailing Address - Fax:518-254-0691
Practice Address - Street 1:139 MERCHANT PLACE
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5715
Practice Address - Country:US
Practice Address - Phone:518-234-1155
Practice Address - Fax:518-254-0691
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC005296-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician