1154472389 NPI number — MR. ARTHUR O LAURY OPTICIAN

Table of content: MR. ARTHUR O LAURY OPTICIAN (NPI 1154472389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154472389 NPI number — MR. ARTHUR O LAURY OPTICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAURY
Provider First Name:
ARTHUR
Provider Middle Name:
O
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OPTICIAN
Provider Gender Code:
M

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:
1154472389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 FAIRMOUNT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14701-2623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-664-4708
Provider Business Mailing Address Fax Number:
716-483-1955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 FAIRMOUNT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14701-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-664-4708
Provider Business Practice Location Address Fax Number:
716-483-1955
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  C0034861 , 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)

  • Identifier: 50495 . This is a "DAVIS VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00602704 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: NY3486 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: NY0486 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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