Provider Demographics
NPI:1174684088
Name:DUTCHESS OPTOMETRY, L.L.P.
Entity Type:Organization
Organization Name:DUTCHESS OPTOMETRY, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:POLENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-471-3650
Mailing Address - Street 1:7 FULTON CT
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2802
Mailing Address - Country:US
Mailing Address - Phone:845-471-3650
Mailing Address - Fax:845-471-1024
Practice Address - Street 1:7 FULTON CT
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2802
Practice Address - Country:US
Practice Address - Phone:845-471-3650
Practice Address - Fax:845-471-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY950427OtherMVP
NY597054OtherMVP
NYC93911OtherBC/BS
NY10032271OtherCDPHP
NYC211C1OtherBC/BS
NYC26381OtherBC/BS
NY903934OtherBLOCK
NY939167OtherMVP
NY597054OtherMVP