Provider Demographics
NPI:1063485381
Name:DELANGE, PAUL S (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:DELANGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3812
Mailing Address - Country:US
Mailing Address - Phone:716-434-2874
Mailing Address - Fax:716-434-7809
Practice Address - Street 1:215 EAST AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3812
Practice Address - Country:US
Practice Address - Phone:716-433-6326
Practice Address - Fax:716-434-7809
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003342-1152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT83131Medicare UPIN
NY070731Medicare ID - Type Unspecified
NY0233150001Medicare NSC