Provider Demographics
NPI:1518187566
Name:UTNICK, PAUL HOWARD (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HOWARD
Last Name:UTNICK
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CHIMNEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3617
Mailing Address - Country:US
Mailing Address - Phone:845-783-0234
Mailing Address - Fax:
Practice Address - Street 1:475 STATE ROUTE 17M
Practice Address - Street 2:PLAZA OPTICAL
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4169
Practice Address - Country:US
Practice Address - Phone:845-783-4400
Practice Address - Fax:845-782-4041
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4866156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician