Provider Demographics
NPI:1639228729
Name:TOWN & COUNTRY OPTICAL,INC.
Entity Type:Organization
Organization Name:TOWN & COUNTRY OPTICAL,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN-MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-793-5395
Mailing Address - Street 1:535 BAY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-3018
Mailing Address - Country:US
Mailing Address - Phone:518-793-5395
Mailing Address - Fax:518-793-5543
Practice Address - Street 1:535 BAY RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3018
Practice Address - Country:US
Practice Address - Phone:518-793-5395
Practice Address - Fax:518-793-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005800332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC9W05OtherEMPIRE BLUE CROSS
NY0139050001Medicare PIN