Provider Demographics
NPI:1972665701
Name:COXSACKIE OPTOMETRIC PC
Entity Type:Organization
Organization Name:COXSACKIE OPTOMETRIC PC
Other - Org Name:COXSACKIE EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAMMERER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-731-9405
Mailing Address - Street 1:83 MANSION ST
Mailing Address - Street 2:
Mailing Address - City:COXSACKIE
Mailing Address - State:NY
Mailing Address - Zip Code:12051-1216
Mailing Address - Country:US
Mailing Address - Phone:518-731-9405
Mailing Address - Fax:
Practice Address - Street 1:10 A ELY ST
Practice Address - Street 2:
Practice Address - City:COXSACKIE
Practice Address - State:NY
Practice Address - Zip Code:12051-1216
Practice Address - Country:US
Practice Address - Phone:518-731-9405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0048681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY59125OtherMVP
NY10000840M202OtherCDPHP
NYC198AOtherEMPIRE BLUE CROSS BLUE SH
NYC198AOtherEMPIRE BLUE CROSS BLUE SH
NY5599180001Medicare NSC
NYC198AOtherEMPIRE BLUE CROSS BLUE SH
NYBA0379Medicare ID - Type UnspecifiedHEALTHNOW UPSTATE NY MEDI
NYDC6319Medicare PIN