Organization
JACK DEVORE, OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK DEVORE OD (OWNER)
(518) 478-9992
Entity
Organization
Contact information
Practice address
4 NORMANSKILL BLVD, DELMAR, NY 12054-1335
(518) 478-9992
(518) 439-0796
Mailing address
4 NORMANSKILL BLVD, DELMAR, NY 12054-1335
(518) 478-9992
(518) 439-0796
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
VUT003734
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410044002
RAILROAD MEDICARE
NY
Enumeration date
03/05/2008
Last updated
09/30/2008
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