Provider Demographics
NPI:1033372305
Name:ROACH, POLLYANNA L (OD)
Entity Type:Individual
Prefix:
First Name:POLLYANNA
Middle Name:L
Last Name:ROACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HAMLIN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1604
Mailing Address - Country:US
Mailing Address - Phone:716-341-2270
Mailing Address - Fax:
Practice Address - Street 1:65 HAMLIN AVE
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1604
Practice Address - Country:US
Practice Address - Phone:716-341-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist