Provider Demographics
NPI:1114961281
Name:POLAO, ERNEST MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:MICHAEL
Last Name:POLAO
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 1:3146 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:NY
Mailing Address - Zip Code:10511-1651
Mailing Address - Country:US
Mailing Address - Phone:914-736-5600
Mailing Address - Fax:914-736-7426
Practice Address - Street 1:3146 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:NY
Practice Address - Zip Code:10511-1651
Practice Address - Country:US
Practice Address - Phone:914-736-5600
Practice Address - Fax:914-736-7426
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT49028Medicare UPIN
410004470Medicare UPIN
0236970001Medicare NSC
NYC32061Medicare PIN