Individual
DR. JACK DEVORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4 NORMANSKILL BLVD, SUITE 400, DELMAR, NY 12054-1335
(518) 478-9992
(518) 439-0796
Mailing address
4 NORMANSKILL BLVD, SUITE 400, DELMAR, NY 12054-1335
(518) 478-9992
(518) 439-0796
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
VUT003734
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000495454001
BS NENY
NY
05
—
01419103
—
NY
01
—
10034805
CDPHP
NY
01
—
410044002
RAILRAOD MEDICARE
NY
01
—
59336
MVP
NY
01
—
C6476
EMPIRE BC
NY
Enumeration date
01/19/2006
Last updated
02/27/2008
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