Old Saratoga Optometry & Ophthalmic Dispensing, PLLC
Organization Active NPI Optometrist · Greenwich, NY
NPI 1275720781 · NPPES record last updated Sep 20, 2019
Key facts
- NPI
- 1275720781
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 005918 (NY)
- Legal business name
- OLD SARATOGA OPTOMETRY & OPHTHALMIC DISPENSING, PLLC
- Practice address
- 1224 State Route 29
Greenwich, NY 12834-6120 - Phone
- (518) 692-2040
- Fax
- (518) 692-2440
- NPI assigned
- Sep 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Angela Gardner, OD
- Title
- Owner
- Phone
- (518) 692-2040
Practitioners 4
-
Angela E Gardner, O.D.
-
Kimberly A Dobrodziej, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050321000327 | NY | Part B Supplier - Clinic/Group Practice | 4688629892 |
Receives reassigned benefits from 1 practitioner Practice locations: Greenwich, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 005918 | NY | Yes |
Addresses
Primary practice location
1224 State Route 29
Greenwich, NY 12834-6120
Mailing address
31 Ferry St
Suite 2
Schuylerville, NY 12871-1225
Phone (518) 695-3040
Other names
- Old Saratoga Eyecare
Other providers in Greenwich, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.