Provider Demographics
NPI:1366520793
Name:WEINSTOCK, ALAN R (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:WEINSTOCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:266 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1134
Mailing Address - Country:US
Mailing Address - Phone:518-439-3551
Mailing Address - Fax:518-439-2508
Practice Address - Street 1:19 CLIFTON COUNTRY RD
Practice Address - Street 2:VILLAGE PLAZA
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3820
Practice Address - Country:US
Practice Address - Phone:518-439-3551
Practice Address - Fax:518-439-2508
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTUV003803OtherLICENSE
NYT22815Medicare UPIN
NYTUV003803OtherLICENSE