Organization
KNAUF OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL JOHN AVERY SR. LICENSED OPTICIAN (OWNER/PARTNER)
(607) 748-0765
Entity
Organization
Contact information
Practice address
235 VESTAL AVE, ENDICOTT, NY 13760-4928
(607) 748-0765
(607) 748-0765
Mailing address
235 VESTAL AVE, ENDICOTT, NY 13760-4928
(607) 748-0765
(607) 748-0765
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
NY6965
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7579607
AETNA
NY
01
—
NY6965
EYEMED
NY
Enumeration date
02/01/2008
Last updated
03/25/2008
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