Provider Demographics
NPI:1750360558
Name:HAGE, LOIS KNACK (OD)
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:KNACK
Last Name:HAGE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MURRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3618
Mailing Address - Country:US
Mailing Address - Phone:607-798-0459
Mailing Address - Fax:
Practice Address - Street 1:501 REYNOLDS RD
Practice Address - Street 2:SEARS OPTICAL, OAKDALE MALL,
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-797-6071
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004417-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52306BMedicare ID - Type Unspecified
NYU05338Medicare UPIN