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Individual

MARK M AINSWORTH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
394 E STATE ST, HERKIMER, NY 13350-2026
(315) 866-9667
(315) 866-9668
Mailing address
394 E STATE ST, HERKIMER, NY 13350-2026
(315) 866-9667
(315) 866-9668

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV005303-1
NY
332H00000X
Eyewear Supplier
TUV005303-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01912927
NY
01
05742
SPECTERA
NY
01
117251
EYEMED
NY
01
493
DAVIS
NY
01
522109986
BCBS
NY
01
595064
MVP
NY
01
NY5303
VISION BENEFITS OF AMERIC
NY
Enumeration date
12/23/2005
Last updated
08/01/2024
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