Provider Demographics
NPI:1063693539
Name:KATHY FERRO WEISS
Entity type:Organization
Organization Name:KATHY FERRO WEISS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTHALMIC DISPENSER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:FERRO
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-754-8670
Mailing Address - Street 1:32 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5450
Practice Address - Country:US
Practice Address - Phone:607-754-8670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003777 1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0131380001Medicare NSC
RA7894Medicare PIN
CC8936Medicare PIN
AA1007Medicare PIN