ENCHANTED MOUNTAIN OPTOMETRYPLLC NPI 1013294685

NPI Information

NPI: 1013294685
Provider Name: ENCHANTED MOUNTAIN OPTOMETRY,PLLC
Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Doing Business As: ENCHANTED MOUNTAIN EYECARE
Address: 912 W STATE ST
OLEAN, NY
ZIP 14760
Phone: (716) 373-0766

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NPI Details

ENCHANTED MOUNTAIN OPTOMETRY,PLLC is an eyewear supplier in Olean, NY. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. ENCHANTED MOUNTAIN OPTOMETRY,PLLC NPI is 1013294685. The provider is registered as an organization entity type.
The provider Is Doing Business As Enchanted Mountain Eyecare.

The provider's business location address is:

912 W STATE ST
OLEAN, NY
ZIP 14760-242
Phone: (716) 373-0766

The provider's authorized official is Tracy L Ludden .
The authorized official title is Optometrist and has the following contact phone number (716) 373-0766.

The enumeration date for this NPI number is 11/10/2011 and was last updated on 11/10/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332H00000X	Eyewear Supplier		T005716	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	LU11809B	MEDICARE UPIN	NEW YORK
2	01608566	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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