Provider Demographics
NPI:1750340386
Name:CANTIE, LAURA ANN (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:CANTIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:50 COBBLESTONE COURT DRIVE
Practice Address - Street 2:EMPIRE VISION CENTERS
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564
Practice Address - Country:US
Practice Address - Phone:585-425-1770
Practice Address - Fax:585-425-2707
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0056451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0305Medicare PIN
NYRB0303Medicare PIN
NYRB0304Medicare PIN
NY53069LMedicare ID - Type Unspecified
U59225Medicare UPIN