Provider Demographics
NPI:1609996008
Name:OSBORN, JOSEPH (OPHTHALMIC DISPENSER)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:OSBORN
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ROUTE 67
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3209
Mailing Address - Country:US
Mailing Address - Phone:518-541-2788
Mailing Address - Fax:
Practice Address - Street 1:1789 ROUTE 9
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2438
Practice Address - Country:US
Practice Address - Phone:518-371-0246
Practice Address - Fax:518-383-9888
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006910-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1172880001OtherDME SUPPLIER
NY1172880001Medicare ID - Type Unspecified
NY1172880001OtherDME SUPPLIER