Provider Demographics
NPI:1124541370
Name:OSSINING FAMILY OPTOMETRY PLLC
Entity type:Organization
Organization Name:OSSINING FAMILY OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:914-923-0300
Mailing Address - Street 1:57 CROTON AVE # 3
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4981
Mailing Address - Country:US
Mailing Address - Phone:914-923-0300
Mailing Address - Fax:914-923-0450
Practice Address - Street 1:57 CROTON AVE # 3
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4981
Practice Address - Country:US
Practice Address - Phone:914-923-0300
Practice Address - Fax:914-923-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007907152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06754407Medicaid