1144284043 NPI number — VISIONARY OPHTHALMOLOGY AND CATARACT CARE, PLLC

Table of content: (NPI 1144284043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144284043 NPI number — VISIONARY OPHTHALMOLOGY AND CATARACT CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISIONARY OPHTHALMOLOGY AND CATARACT 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:
Provider Other Organization Name Type Code:
6
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:
1144284043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 N UNION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-5339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 N UNION RD
Provider Second Line Business Practice Location Address:
NISWANDER EYE CENTER
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-5339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-634-4441
Provider Business Practice Location Address Fax Number:
716-634-3174
Provider Enumeration Date:
04/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NISWANDER
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
MD/PARTNER
Authorized Official Telephone Number:
716-634-4441

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  VUT005781-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 142714 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01632920 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390088001 . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".