Provider Demographics
NPI:1942344148
Name:SARATOGA OPTOMETRIC ASSOC, PC
Entity Type:Organization
Organization Name:SARATOGA OPTOMETRIC ASSOC, PC
Other - Org Name:SARATOGA VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-587-5900
Mailing Address - Street 1:235 WASHINGTON ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5962
Mailing Address - Country:US
Mailing Address - Phone:518-587-5900
Mailing Address - Fax:518-587-5938
Practice Address - Street 1:235 WASHINGTON ST
Practice Address - Street 2:STE 1
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5962
Practice Address - Country:US
Practice Address - Phone:518-587-5900
Practice Address - Fax:518-587-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003537152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39674AMedicare ID - Type Unspecified
0675680001Medicare NSC
NYSP2149OtherMVP HEALTHPLAN