Devore, Jack
Devore, Jack is an sole proprietor health care provider with primary practice located at 4 Normanskill Blvd Suite 400, Delmar NY 12054-1335. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Devore, Jack can be contacted via phone (518) 478-9992.Contact Information
Primary practice address
4 Normanskill Blvd Suite 400
Delmar NY 12054-1335
Phone: (518) 478-9992
Fax: (518) 439-0796
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | VUT003734 | New York |
Profile Details
| NPI number | 1023098555 |
|---|---|
| LBN Legal business name | Devore, Jack |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 19th, 2006 |
| Last updated | Feb 27th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023098555 | NPPES |
| New York | Other | 10034805 | CDPHP |
| New York | Other | C6476 | CDPHP |
| New York | Other | 000495454001 | CDPHP |
| New York | Other | 410044002 | CDPHP |
| New York | MEDICAID | 01419103 | CDPHP |
| New York | Other | 59336 | CDPHP |
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