Provider Demographics
NPI:1811276439
Name:SAMANIEGO, ERIC ARAYATA (ABOC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ARAYATA
Last Name:SAMANIEGO
Suffix:
Gender:M
Credentials:ABOC
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Mailing Address - Street 1:52 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-1802
Mailing Address - Country:US
Mailing Address - Phone:845-342-8688
Mailing Address - Fax:
Practice Address - Street 1:1201 UNION AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1633
Practice Address - Country:US
Practice Address - Phone:845-567-0068
Practice Address - Fax:845-567-3098
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-13
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005867-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician