Organization
OPTICAL DISPENSARY INC
Active
Organization
OPTICAL DISPENSARY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE C. MINGER (PRESIDENT)
(315) 331-7917
Entity
Organization
Contact information
Practice address
117 E UNION ST, NEWARK, NY 14513-1503
(315) 331-7917
(315) 331-7917
Mailing address
117 E UNION ST, NEWARK, NY 14513-1503
(315) 331-7917
(315) 331-7917
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
004325
NY
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017510226
BC/BS PROVIDER#
NY
05
—
01782085
—
NY
01
—
103080CT
PREFERRED CARE PROVIDER#
NY
Enumeration date
07/07/2006
Last updated
07/28/2022
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