1407629033 NPI number — SCHAEFER OCULOFACIAL PLASTIC SURGERY, PLLC

Table of content: CAMILLE BROWN M.S., CGC (NPI 1033912480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407629033 NPI number — SCHAEFER OCULOFACIAL PLASTIC SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHAEFER OCULOFACIAL PLASTIC SURGERY, PLLC
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:
1407629033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
467 HAMMOCKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14127-1685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-479-8489
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 SUMMER ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14209-2256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-479-8489
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAEFER
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
LEA
Authorized Official Title or Position:
OPHTHALMOLOGIST / OWNER
Authorized Official Telephone Number:
716-479-8489

Provider Taxonomy Codes

  • Taxonomy code: 207WX0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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