Provider Demographics
NPI:1194179382
Name:GATEWAY OPHTHALMOLOGY, P.L.L.C
Entity Type:Organization
Organization Name:GATEWAY OPHTHALMOLOGY, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-483-2020
Mailing Address - Street 1:27 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6221
Mailing Address - Country:US
Mailing Address - Phone:716-483-2020
Mailing Address - Fax:716-488-9295
Practice Address - Street 1:2 MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2035
Practice Address - Country:US
Practice Address - Phone:814-362-7477
Practice Address - Fax:814-362-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047466L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty