Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV005308 | NY |
NPI | 1003972399 |
---|---|
Provider Name | Joseph A Carrock |
First Address | New Hartford, NY 13413-6203 |
Second Address | New Hartford, NY 13413-6203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 14/10/2015 |