Provider Demographics
NPI:1790846111
Name:POUGHKEEPSIE OPTOMETRY PC
Entity Type:Organization
Organization Name:POUGHKEEPSIE OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEWICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-471-7708
Mailing Address - Street 1:301 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603
Mailing Address - Country:US
Mailing Address - Phone:845-471-7708
Mailing Address - Fax:845-471-1244
Practice Address - Street 1:301 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603
Practice Address - Country:US
Practice Address - Phone:845-471-7708
Practice Address - Fax:845-471-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4700310001Medicare NSC
CGWFA1Medicare PIN