Provider Demographics
NPI:1871735191
Name:BURNT HILLS OPTICAL, INC
Entity type:Organization
Organization Name:BURNT HILLS OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ OPTICIAN/ MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-399-6130
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-0209
Mailing Address - Country:US
Mailing Address - Phone:518-399-6130
Mailing Address - Fax:518-399-4064
Practice Address - Street 1:793 ROUTE 50
Practice Address - Street 2:
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027-9501
Practice Address - Country:US
Practice Address - Phone:519-399-6130
Practice Address - Fax:518-399-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6240220001Medicare NSC