Provider Demographics
NPI:1578613006
Name:BIRDSALL, JOHN GADSBY III (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GADSBY
Last Name:BIRDSALL
Suffix:III
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10 VINE ST.
Mailing Address - Street 2:PO BOX 28
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13776
Mailing Address - Country:US
Mailing Address - Phone:607-783-2222
Mailing Address - Fax:607-336-1003
Practice Address - Street 1:5811 COUNTY RT. 32
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-336-2020
Practice Address - Fax:607-336-1003
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY5008156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician