Provider Demographics
NPI:1679949879
Name:EYE Q OF CNY LLC
Entity type:Organization
Organization Name:EYE Q OF CNY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANNAGER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-797-2020
Mailing Address - Street 1:4660 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-6203
Mailing Address - Country:US
Mailing Address - Phone:315-797-2020
Mailing Address - Fax:
Practice Address - Street 1:4660 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-6203
Practice Address - Country:US
Practice Address - Phone:315-797-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
NY008511332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty