Provider Demographics
NPI:1033304597
Name:LEGARRETA EYE CENTER
Entity Type:Organization
Organization Name:LEGARRETA EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOGIST/OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LEGARRETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-668-3030
Mailing Address - Street 1:1301 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3277
Mailing Address - Country:US
Mailing Address - Phone:716-633-2203
Mailing Address - Fax:716-633-7738
Practice Address - Street 1:1301 N FOREST RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3277
Practice Address - Country:US
Practice Address - Phone:716-633-2203
Practice Address - Fax:716-633-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124124152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00624162Medicaid
NY075292OtherLEGACY NUMBER
NYA75292Medicare PIN
NY075292OtherLEGACY NUMBER