Individual
JOHANNA VANDEUSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPHTHALMIC DISPENSER
Contact information
Practice address
261 CENTER ST, FRANKLIN, NY 13775-0026
(607) 287-4986
Mailing address
PO BOX 26, FRANKLIN, NY 13775-0026
(607) 287-4986
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
008960-1
NY
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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