Provider Demographics
NPI:1093069197
Name:VISION ASSOCIATES OF ROCHESTER
Entity Type:Organization
Organization Name:VISION ASSOCIATES OF ROCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER/OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-254-0022
Mailing Address - Street 1:1260 LYELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2040
Mailing Address - Country:US
Mailing Address - Phone:585-254-0022
Mailing Address - Fax:585-254-5026
Practice Address - Street 1:2449 3RD AVE S
Practice Address - Street 2:C26
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2690
Practice Address - Country:US
Practice Address - Phone:585-254-0022
Practice Address - Fax:585-254-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2774191332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier