Provider Demographics
NPI:1386461564
Name:VEDDER, MEGAN JANE
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:JANE
Last Name:VEDDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-6227
Mailing Address - Country:US
Mailing Address - Phone:315-736-6901
Mailing Address - Fax:315-736-6947
Practice Address - Street 1:4765 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-6227
Practice Address - Country:US
Practice Address - Phone:315-736-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010125-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician