Provider Demographics
NPI:1164499042
Name:SAINI, NITA (OD)
Entity type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:SAINI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 TOWNE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1336
Mailing Address - Country:US
Mailing Address - Phone:315-632-6036
Mailing Address - Fax:315-632-6038
Practice Address - Street 1:103 TOWNE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1336
Practice Address - Country:US
Practice Address - Phone:315-632-6036
Practice Address - Fax:315-632-6038
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005917-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02604346Medicaid
NY5244700001Medicare NSC
NY02604346Medicaid
NYU70906Medicare UPIN
NYBA0254Medicare ID - Type UnspecifiedGROUP PROVIDER #