Provider Demographics
NPI:1609857150
Name:ZUCK, ALLEN F (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:F
Last Name:ZUCK
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 1:52 NEW HARTFORD SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2144
Mailing Address - Country:US
Mailing Address - Phone:315-735-7590
Mailing Address - Fax:315-732-0769
Practice Address - Street 1:52 NEW HARTFORD SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2144
Practice Address - Country:US
Practice Address - Phone:315-735-7590
Practice Address - Fax:315-732-0769
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTU003939-1152WL0500X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00489092Medicaid
NY51322BMedicare ID - Type UnspecifiedMEDICARE
NY00489092Medicaid