1659484996 NPI number — PARK SHER OPTICAL CO OF BUFFALO NY INC

Table of content: (NPI 1659484996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659484996 NPI number — PARK SHER OPTICAL CO OF BUFFALO NY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARK SHER OPTICAL CO OF BUFFALO NY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659484996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3035 GENESEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14225-2661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-896-3351
Provider Business Mailing Address Fax Number:
716-896-0171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3035 GENESEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEEKTOWAGA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14225-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-896-3351
Provider Business Practice Location Address Fax Number:
716-896-0171
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEYER
Authorized Official First Name:
JILLIAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
716-896-3351

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0061482 . This is a "GROUP HEALTH INCORPORATED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY3434 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 679 . This is a "DAVISVISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000300013009 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 330421 . This is a "NATIONAL VISION ADMINISTR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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