Provider Demographics
NPI:1205378882
Name:ALLEGANY OPHTHALMOLOGY, PLLC
Entity Type:Organization
Organization Name:ALLEGANY OPHTHALMOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-372-9464
Mailing Address - Street 1:34 BROADWAY MALL
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1920
Mailing Address - Country:US
Mailing Address - Phone:607-324-7710
Mailing Address - Fax:716-790-8126
Practice Address - Street 1:34 BROADWAY MALL
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1920
Practice Address - Country:US
Practice Address - Phone:607-324-7710
Practice Address - Fax:716-790-8126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
J100082768OtherMEDICARE PTAN