Provider Demographics
NPI:1639202211
Name:CONLEY, ERIC JASON (OD, MJ)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JASON
Last Name:CONLEY
Suffix:
Gender:M
Credentials:OD, MJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 MEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3604
Mailing Address - Country:US
Mailing Address - Phone:516-587-9332
Mailing Address - Fax:
Practice Address - Street 1:214 WALL ST STE 100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7804
Practice Address - Country:US
Practice Address - Phone:516-587-9332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4914152W00000X
CT3.002873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist