Provider Demographics
NPI:1326287293
Name:PATRICIA D. CARUSO,O.D.
Entity Type:Organization
Organization Name:PATRICIA D. CARUSO,O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-877-8170
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0455
Mailing Address - Country:US
Mailing Address - Phone:518-877-8170
Mailing Address - Fax:
Practice Address - Street 1:101 SANFORD FARMS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7535
Practice Address - Country:US
Practice Address - Phone:518-843-0189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004887-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U38556Medicare UPIN