1982715686 NPI number — LPEC MEDICAL EYE CARE PLLC

Table of content: (NPI 1982715686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982715686 NPI number — LPEC MEDICAL EYE CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LPEC MEDICAL EYE CARE 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:
LAKE PLAINS EYE CENTER
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:
1982715686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ERIE ST SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14103-1010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-798-2020
Provider Business Mailing Address Fax Number:
585-798-3365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 ERIE ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14103-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-798-2020
Provider Business Practice Location Address Fax Number:
585-798-3365
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WATTS
Authorized Official First Name:
ELAINE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
585-798-2020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: 120403 , 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)

  • Identifier: P017812763 . This is a "BLUE CHOICE ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02873274 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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