Provider Demographics
NPI:1477052223
Name:POULIN OPTOMETRIC EYECARE , PLLC
Entity Type:Organization
Organization Name:POULIN OPTOMETRIC EYECARE , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:POULIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-245-2443
Mailing Address - Street 1:2471 STATE ROUTE 69
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-3728
Mailing Address - Country:US
Mailing Address - Phone:315-245-3963
Mailing Address - Fax:315-245-1060
Practice Address - Street 1:94 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1320
Practice Address - Country:US
Practice Address - Phone:315-245-2443
Practice Address - Fax:315-245-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0003386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty