Provider Demographics
NPI:1427100486
Name:BALFE, CAROL ANN (OD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:BALFE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:CANAJOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:13317-3239
Mailing Address - Country:US
Mailing Address - Phone:518-673-2241
Mailing Address - Fax:
Practice Address - Street 1:70 ERIE BLVD
Practice Address - Street 2:
Practice Address - City:CANAJOHARIE
Practice Address - State:NY
Practice Address - Zip Code:13317-1133
Practice Address - Country:US
Practice Address - Phone:518-673-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT-005534-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist