Provider Demographics
NPI:1043346554
Name:SHEEHY OPTICIANS OPHTHALMIC DISPENSERS PC
Entity type:Organization
Organization Name:SHEEHY OPTICIANS OPHTHALMIC DISPENSERS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SHEEHY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:518-482-4688
Mailing Address - Street 1:291 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3123
Mailing Address - Country:US
Mailing Address - Phone:518-482-4688
Mailing Address - Fax:518-482-8245
Practice Address - Street 1:291 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3123
Practice Address - Country:US
Practice Address - Phone:518-482-4688
Practice Address - Fax:518-482-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5209156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0823580001Medicare NSC
NY0823580001Medicare NSC