Provider Demographics
NPI:1104669571
Name:CRUZ, FELIPE (LDO)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DUTCH MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3546
Mailing Address - Country:US
Mailing Address - Phone:518-344-7634
Mailing Address - Fax:518-344-7636
Practice Address - Street 1:200 DUTCH MEADOWS LN
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-3546
Practice Address - Country:US
Practice Address - Phone:518-344-7634
Practice Address - Fax:518-344-7636
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009386156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician