Provider Demographics
NPI:1578863569
Name:COPELAND FERTIG & KRAMER OPTOMETRIC EYE ASSOCIATES LLP
Entity Type:Organization
Organization Name:COPELAND FERTIG & KRAMER OPTOMETRIC EYE ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERTIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:9149-390-8300
Mailing Address - Street 1:204 S RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3434
Mailing Address - Country:US
Mailing Address - Phone:914-939-0830
Mailing Address - Fax:
Practice Address - Street 1:204 S RIDGE ST
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-3434
Practice Address - Country:US
Practice Address - Phone:914-939-0830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100041362Medicare PIN