Provider Demographics
NPI:1538128681
Name:BOOTON, DEBRA A (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:BOOTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:2921 ERIE BLVD E
Practice Address - Street 2:EMPIRE VISION CENTERS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224
Practice Address - Country:US
Practice Address - Phone:315-446-5120
Practice Address - Fax:315-446-5177
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT0037141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U55915Medicare UPIN
NYRB1276Medicare PIN
NYRB1278Medicare PIN
NYCC0130Medicare ID - Type Unspecified
NYRB1274Medicare PIN