Basic Information
| Provider Information | |||||||||
| NPI: | 1942344148 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SARATOGA OPTOMETRIC ASSOC, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SARATOGA VISION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 WASHINGTON ST | ||||||||
| Address2: | STE 1 | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128665962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185875900 | ||||||||
| FaxNumber: | 5185875938 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 WASHINGTON ST | ||||||||
| Address2: | STE 1 | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128665962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185875900 | ||||||||
| FaxNumber: | 5185875938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2007 | ||||||||
| LastUpdateDate: | 02/26/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHING | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5185875900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | TUV003537 | NY | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 152W00000X | TUV003537 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.