1609099563 NPI number — CREIGHTON OPTICAL

Table of content: (NPI 1609099563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609099563 NPI number — CREIGHTON OPTICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREIGHTON OPTICAL
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:
JAMES F. CREIGHTON, OPTICIAN
Provider Other Organization Name Type Code:
3
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:
1609099563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13375 BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14004-1410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-937-7373
Provider Business Mailing Address Fax Number:
716-937-4136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13375 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALDEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14004-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-937-7373
Provider Business Practice Location Address Fax Number:
716-937-4136
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CREIGHTON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OPTICIAN OWNER
Authorized Official Telephone Number:
716-937-7373

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  UT003462 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: V0048731 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 3610 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X , with the licence number: 2738 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X , with the licence number: 6357 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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