Provider Demographics
NPI:1457427809
Name:SANDY, BETH A (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:SANDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:JACOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1300 ULSTER AVE. #1200
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-336-5878
Mailing Address - Fax:845-336-5890
Practice Address - Street 1:1300 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1501
Practice Address - Country:US
Practice Address - Phone:845-336-5878
Practice Address - Fax:845-336-5890
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006236-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY TUV006236-1OtherSTATE LICENSE