1962479949 NPI number — UNIVERSITY OPTICAL CORP

Table of content: (NPI 1962479949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962479949 NPI number — UNIVERSITY OPTICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OPTICAL CORP
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:
1962479949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2469 STATE ROUTE 19 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARSAW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14569-9336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-786-8505
Provider Business Mailing Address Fax Number:
585-786-8490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2469 STATE ROUTE 19 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14569-9336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-786-8505
Provider Business Practice Location Address Fax Number:
585-786-8490
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUBER
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
585-786-8505

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00011258003 . This is a "UNIVERA HEALTHCARE BUFFAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OP1387 . This is a "EYEMED/INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 106386CT . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P017157362 . This is a "BCBS ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0005177624 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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