| NPI | 1932307014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANDREW DIVIETRO Owner 315-253-7032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NY C006767-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV004966-1) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2008-01-07 |