Provider Demographics
NPI:1073976692
Name:WESTSIDE OPTOMETRY PLLC
Entity Type:Organization
Organization Name:WESTSIDE OPTOMETRY PLLC
Other - Org Name:WESTSIDE EYECARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-571-9034
Mailing Address - Street 1:250 MILE CROSSING BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-6242
Mailing Address - Country:US
Mailing Address - Phone:585-571-9034
Mailing Address - Fax:585-471-8827
Practice Address - Street 1:250 MILE CROSSING BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-6242
Practice Address - Country:US
Practice Address - Phone:585-571-9034
Practice Address - Fax:585-471-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26100Medicare UPIN
NY0837970001Medicare NSC