Provider Demographics
NPI:1629124649
Name:TRI-COUNTY EYE CARE AND OPTOMETRY PC
Entity Type:Organization
Organization Name:TRI-COUNTY EYE CARE AND OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-747-4100
Mailing Address - Street 1:3685 BURGOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-2168
Mailing Address - Country:US
Mailing Address - Phone:518-747-4100
Mailing Address - Fax:518-747-6151
Practice Address - Street 1:3685 BURGOYNE AVE
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-2168
Practice Address - Country:US
Practice Address - Phone:518-747-4100
Practice Address - Fax:518-747-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006839-1152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY782077OtherMVP
NY10089360OtherCDPHP
NY000408532001OtherBSNENY
NYC369F1OtherEMPIRE
NY000408532001OtherBSNENY
NY5819250001Medicare NSC
NYBA0567Medicare PIN