Provider Demographics
NPI:1932255809
Name:CONLEY, NANCY D (OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:D
Last Name:CONLEY
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MERMAN DR
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1160
Mailing Address - Country:US
Mailing Address - Phone:315-885-1956
Mailing Address - Fax:
Practice Address - Street 1:3662 THE PARK
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3324
Practice Address - Country:US
Practice Address - Phone:607-753-7514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005031-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician