Organization
ENCHANTED MOUNTAIN OPTOMETRY,PLLC
Active
Other names
Enchanted Mountain Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY L LUDDEN OD (OPTOMETRIST)
(716) 373-0766
Entity
Organization
Contact information
Practice address
912 W STATE ST, OLEAN, NY 14760-2242
(716) 373-0766
Mailing address
912 W STATE ST, OLEAN, NY 14760-2242
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
T005716
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01608566
—
NY
Enumeration date
11/10/2011
Last updated
11/10/2011
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