Individual
JOHN J. COSTELLO, SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
131 MAIN ST, SUITE 202, ONEIDA, NY 13421-1641
(315) 363-4942
(315) 363-4441
Mailing address
131 MAIN ST, SUITE 202, ONEIDA, NY 13421-1641
(315) 363-4942
(315) 363-4441
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV002717-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02961255
—
NY
Enumeration date
11/07/2006
Last updated
01/14/2014
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