Organization
ACTIVERXEYEWEAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. COLEEN KERN OPTICIAN (OWNER OPTICIAN)
(518) 785-4674
Entity
Organization
Contact information
Practice address
830 HOOSICK RD, TROY, NY 12180-6665
(518) 274-5559
(518) 677-1129
Mailing address
9 FIET AVE, TROY, NY 12180-6715
(518) 785-4674
(518) 785-4675
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
7230-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7230NY
EYEMED VISION CARE
NY
Enumeration date
12/29/2006
Last updated
12/22/2010
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