Provider Demographics
NPI:1720527369
Name:ROBERT K DRUGER DRUGER OPTICAL
Entity Type:Organization
Organization Name:ROBERT K DRUGER DRUGER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:DRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-634-1608
Mailing Address - Street 1:5633 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1324
Mailing Address - Country:US
Mailing Address - Phone:315-634-1608
Mailing Address - Fax:315-488-0047
Practice Address - Street 1:5633 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1324
Practice Address - Country:US
Practice Address - Phone:315-634-1608
Practice Address - Fax:315-488-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210355332H00000X
NYC005879-1332H00000X
NY006685-1332H00000X
NYTUV006882332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5244700001Medicare NSC