Provider Demographics
NPI:1588188973
Name:MONTES, ADRIAN (OD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:MONTES
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 1:225 WILKINSON ST APT 316
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2450
Mailing Address - Country:US
Mailing Address - Phone:651-621-9126
Mailing Address - Fax:
Practice Address - Street 1:6859 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1086
Practice Address - Country:US
Practice Address - Phone:315-251-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008641-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist