Basic Information
| Provider Information | |||||||||
| NPI: | 1053827618 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARNEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LDO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1818 STATE ROUTE 3 | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130691572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155981668 | ||||||||
| FaxNumber: | 3155981671 | ||||||||
| Practice Location | |||||||||
| Address1: | 1818 STATE ROUTE 3 | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130691572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155981668 | ||||||||
| FaxNumber: | 3155981671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2017 | ||||||||
| LastUpdateDate: | 12/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 010023-1 | NY | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.