Provider Demographics
NPI:1386926954
Name:NORTH COUNTRY VISION CENTER
Entity type:Organization
Organization Name:NORTH COUNTRY VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:GARRAND
Authorized Official - Last Name:BUREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-338-3080
Mailing Address - Street 1:118 QUAKER RD STE 6
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1755
Mailing Address - Country:US
Mailing Address - Phone:518-338-3080
Mailing Address - Fax:518-338-3081
Practice Address - Street 1:118 QUAKER RD STE 6
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1755
Practice Address - Country:US
Practice Address - Phone:518-338-3080
Practice Address - Fax:518-338-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty