Provider Demographics
NPI:1649491994
Name:UTNICK, BETSY (NYS LIC OPTICIAN)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:UTNICK
Suffix:
Gender:F
Credentials:NYS LIC OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CHIMNEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3617
Mailing Address - Country:US
Mailing Address - Phone:845-783-0234
Mailing Address - Fax:
Practice Address - Street 1:475 STATE ROUTE 17M
Practice Address - Street 2:PLAZA OPTICAL
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4169
Practice Address - Country:US
Practice Address - Phone:845-783-4400
Practice Address - Fax:845-782-4041
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC005082-1156FC0801X
NYC50082-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician