Provider Demographics
NPI:1972782589
Name:YORK, JAMES PERRY JR (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PERRY
Last Name:YORK
Suffix:JR
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8472
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-0472
Mailing Address - Country:US
Mailing Address - Phone:518-785-8810
Mailing Address - Fax:
Practice Address - Street 1:313 OLD NISKAYUNA RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2214
Practice Address - Country:US
Practice Address - Phone:518-785-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4151156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00629158Medicaid
NY0820110001Medicare UPIN