Provider Demographics
NPI:1538483151
Name:JENNIFER J DOTTERWEICH OPTOMETRY, PC
Entity Type:Organization
Organization Name:JENNIFER J DOTTERWEICH OPTOMETRY, PC
Other - Org Name:LIVINGSTON EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOTTERWEICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-226-3400
Mailing Address - Street 1:243 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-1475
Mailing Address - Country:US
Mailing Address - Phone:508-837-3790
Mailing Address - Fax:585-438-4148
Practice Address - Street 1:243 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1421
Practice Address - Country:US
Practice Address - Phone:585-226-3400
Practice Address - Fax:585-438-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6150152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6358210001OtherMEDICARE PTAN
NYU86791Medicare UPIN
NY6358210001Medicare NSC