Provider Demographics
NPI:1215036405
Name:ADIRONDACK EYECARE CENTER INC
Entity Type:Organization
Organization Name:ADIRONDACK EYECARE CENTER INC
Other - Org Name:ADIRONDACK EYECARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VINCI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-942-2122
Mailing Address - Street 1:6 HEADWATERS PLZ
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-1300
Mailing Address - Country:US
Mailing Address - Phone:315-942-2122
Mailing Address - Fax:315-942-2084
Practice Address - Street 1:6 HEADWATERS PLZ
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-1300
Practice Address - Country:US
Practice Address - Phone:315-942-2122
Practice Address - Fax:315-942-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0572Medicare ID - Type Unspecified
NY5440390001Medicare NSC