Provider Demographics
NPI:1245398775
Name:AIDONE, DAVID JOHN (NYS OPTICIAN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:AIDONE
Suffix:
Gender:M
Credentials:NYS OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 E MAIN ST
Mailing Address - Street 2:STE2
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-5742
Mailing Address - Country:US
Mailing Address - Phone:518-234-2020
Mailing Address - Fax:518-234-0092
Practice Address - Street 1:980 E MAIN ST
Practice Address - Street 2:STE2
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5742
Practice Address - Country:US
Practice Address - Phone:518-234-2020
Practice Address - Fax:518-234-0092
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006746156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
C6683OtherEMPIRE PLAN
NY000496936001OtherBS OF NENY
C6683OtherEMPIRE PLAN