Provider Demographics
NPI:1205990157
Name:DAVID J. DEXTER, O.D., P.C.
Entity type:Organization
Organization Name:DAVID J. DEXTER, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JUDSON
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-343-2020
Mailing Address - Street 1:303 W SENECA ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1831
Mailing Address - Country:US
Mailing Address - Phone:315-343-2020
Mailing Address - Fax:315-207-2001
Practice Address - Street 1:303 W SENECA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1831
Practice Address - Country:US
Practice Address - Phone:315-343-2020
Practice Address - Fax:315-207-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6508152W00000X
NYTUV007521-1152W00000X
NY3632152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02491014Medicaid
NYDF6440OtherPALMETTO GBA-RR MC
NYAA1303Medicare PIN
NYDF6440OtherPALMETTO GBA-RR MC