1659779338 NPI number — PARK-SHER OPTICAL CO OF BUFFALO, NY INC

Table of content: (NPI 1659779338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659779338 NPI number — PARK-SHER OPTICAL CO OF BUFFALO, NY INC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
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:
1659779338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
642 SHERIDAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14150-7853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-695-3733
Provider Business Mailing Address Fax Number:
716-646-3926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
642 SHERIDAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14150-7853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-695-3733
Provider Business Practice Location Address Fax Number:
716-646-3926
Provider Enumeration Date:
12/12/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEYER
Authorized Official First Name:
JILLIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
716-695-3733

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  07272 , 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: 007272 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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