1134391725 NPI number — VISION CARE CENTER

Table of content: (NPI 1134391725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134391725 NPI number — VISION CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION CARE CENTER
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:
1134391725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/11/2008
NPI Reactivation Date:
12/19/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 KAYMAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14228-3466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-693-4606
Provider Business Mailing Address Fax Number:
716-693-7329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2126 NIAGARA FALLS BLVD
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:
14150-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-693-4606
Provider Business Practice Location Address Fax Number:
716-693-7329
Provider Enumeration Date:
03/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BARTELS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER OPTOMETRIST
Authorized Official Telephone Number:
716-693-4606

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV004096-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: TUV004096-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X , with the licence number: TUV004096-1 , 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: 00030024001 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10227701 . This is a "BUFFALO COMMUNITY HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5748343 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 004141 . This is a "MEDICARE PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010227701 . This is a "UNIVERA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7209531 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY4096 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY04096 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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