Provider Demographics
NPI:1801229620
Name:DRYDEN OPTOMETRY P.C.
Entity Type:Organization
Organization Name:DRYDEN OPTOMETRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:CLARE
Authorized Official - Last Name:OLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:607-351-2668
Mailing Address - Street 1:88 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-8500
Mailing Address - Country:US
Mailing Address - Phone:607-844-9477
Mailing Address - Fax:607-844-9478
Practice Address - Street 1:88 NORTH ST
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053-8500
Practice Address - Country:US
Practice Address - Phone:607-844-9477
Practice Address - Fax:607-844-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty