1962577569 NPI number — LICATA OPTICAL CO INC

Table of content: (NPI 1962577569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962577569 NPI number — LICATA OPTICAL CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LICATA OPTICAL CO INC
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:
1962577569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8070 TRANSIT ROAD
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-631-3860
Provider Business Mailing Address Fax Number:
716-631-3090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8070 TRANSIT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-631-3860
Provider Business Practice Location Address Fax Number:
716-631-3090
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LICATA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER OPERATOR
Authorized Official Telephone Number:
716-631-3860

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7310246 . This is a "IND HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000300065001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 333541 . This is a "NATIONAL VISION ADM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026918201 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 46028 . This is a "SPECTERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 008564 . This is a "BLOCK VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 294082 . This is a "HIMARK CLARITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OP022902 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OP2234 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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