Provider Demographics
NPI:1750463006
Name:EYE DESIGNS UNLIMITED OPTOMETRY PC
Entity Type:Organization
Organization Name:EYE DESIGNS UNLIMITED OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-732-1151
Mailing Address - Street 1:289 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3804
Mailing Address - Country:US
Mailing Address - Phone:315-732-1511
Mailing Address - Fax:
Practice Address - Street 1:289 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-3804
Practice Address - Country:US
Practice Address - Phone:315-732-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0051531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4312710002Medicare NSC
NYAA0861Medicare PIN