Provider Demographics
NPI:1780959726
Name:FAZZARY EYE CARE, LLC
Entity type:Organization
Organization Name:FAZZARY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FAZZARY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-499-9131
Mailing Address - Street 1:2700 COUNTY ROAD 17
Mailing Address - Street 2:
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-9401
Mailing Address - Country:US
Mailing Address - Phone:917-499-9131
Mailing Address - Fax:
Practice Address - Street 1:29 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1252
Practice Address - Country:US
Practice Address - Phone:917-499-9131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty