Provider Demographics
NPI:1235330929
Name:AURORA OPTOMETRIC GROUP, P.C.
Entity Type:Organization
Organization Name:AURORA OPTOMETRIC GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-492-1958
Mailing Address - Street 1:1 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-1401
Mailing Address - Country:US
Mailing Address - Phone:585-492-1958
Mailing Address - Fax:595-496-5722
Practice Address - Street 1:1 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ARCADE
Practice Address - State:NY
Practice Address - Zip Code:14009-1401
Practice Address - Country:US
Practice Address - Phone:585-492-1958
Practice Address - Fax:595-496-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011387602OtherUNIVERA GROUP #
NY00011387602OtherUNIVERA GROUP #
NY0352670005Medicare NSC