Provider Demographics
NPI:1558447797
Name:COLLINS, PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ROUTE 300
Mailing Address - Street 2:NEWBURGH MALL
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2990
Mailing Address - Country:US
Mailing Address - Phone:845-566-9179
Mailing Address - Fax:845-566-9192
Practice Address - Street 1:1401 ROUTE 300
Practice Address - Street 2:NEWBURGH MALL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2990
Practice Address - Country:US
Practice Address - Phone:845-566-9179
Practice Address - Fax:845-566-9192
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004272-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03083992Medicaid