Provider Demographics
NPI:1689882151
Name:CHENANGO VISION CENTER, INC.
Entity Type:Organization
Organization Name:CHENANGO VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BIRDSALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-336-2020
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:5811 CO. RT. 32
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3904
Mailing Address - Country:US
Mailing Address - Phone:607-336-2020
Mailing Address - Fax:607-336-1003
Practice Address - Street 1:5811 CO. RT. 32
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3904
Practice Address - Country:US
Practice Address - Phone:607-336-2020
Practice Address - Fax:607-336-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005032152W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0848760001Medicare NSC
NY55094AMedicare ID - Type Unspecified