Provider Demographics
NPI:1902312556
Name:MALTAVISTA OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:MALTAVISTA OPTOMETRY, PLLC
Other - Org Name:MALTAVISTA OPTOMETRY & ORTHOKERATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALPIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-800-0991
Mailing Address - Street 1:8 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2715 RT 9
Practice Address - Street 2:SUITE 204
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:973-800-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty