Provider Demographics
NPI:1528367067
Name:CONVERSE, GEANA MARIA (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:GEANA
Middle Name:MARIA
Last Name:CONVERSE
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2158
Mailing Address - Country:US
Mailing Address - Phone:315-767-0209
Mailing Address - Fax:315-755-2091
Practice Address - Street 1:608 PEARL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2158
Practice Address - Country:US
Practice Address - Phone:315-767-0209
Practice Address - Fax:315-755-2091
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007846156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician