Provider Demographics
NPI:1568759850
Name:LACORTE, EDWARD ALEXANDER (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALEXANDER
Last Name:LACORTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 MANHATTAN AVE
Mailing Address - Street 2:APT 4K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2623
Mailing Address - Country:US
Mailing Address - Phone:607-316-2846
Mailing Address - Fax:
Practice Address - Street 1:811 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-5202
Practice Address - Country:US
Practice Address - Phone:718-924-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007791-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist