Provider Demographics
NPI:1093147902
Name:EYES DOWNTOWN
Entity Type:Organization
Organization Name:EYES DOWNTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-883-9550
Mailing Address - Street 1:902 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1403
Mailing Address - Country:US
Mailing Address - Phone:716-883-9550
Mailing Address - Fax:716-883-9551
Practice Address - Street 1:902 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1403
Practice Address - Country:US
Practice Address - Phone:716-883-9550
Practice Address - Fax:716-883-9551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOBS EYES DOWNTOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03161415Medicaid