Organization
GOVERNMENT EYE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLER JOSEPH MAXON O.D. (OPTOMETRIST)
(760) 819-1141
Entity
Organization
Contact information
Practice address
2264 SARANAC AVE, LAKE PLACID, NY 12946-3383
(518) 302-5578
Mailing address
5160 KINLOCH CIR, FAYETTEVILLE, NY 13066-9681
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV008307
NY
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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