1215077979 NPI number — KWIK VISION

Table of content: (NPI 1215077979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215077979 NPI number — KWIK VISION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KWIK VISION
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:
1215077979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 MIRACLE MILE DR
Provider Second Line Business Mailing Address:
DBA COHENS FASHION OPTICAL
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14623-5862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-475-0250
Provider Business Mailing Address Fax Number:
585-475-1703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 MIRACLE MILE DR
Provider Second Line Business Practice Location Address:
DBA COHENS FASHION OPTICAL
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14623-5862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-475-0250
Provider Business Practice Location Address Fax Number:
585-475-1703
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KWIK
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
585-281-0321

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  006383 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: 006383 , 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: P017002559 . This is a "BLUE CHOICE VENDOR PID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7978635 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010016383 . This is a "EXCELLUS-BLUE CHOICE HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 123100CS . This is a "PREFERRED CARE HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P050016383 . This is a "EXCELLUS-BLUE SHIELD PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY6383 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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