Provider Demographics
NPI:1275666190
Name:WESTERN NEW YORK CENTER FOR THE VISUALLY IMPAIRED
Entity Type:Organization
Organization Name:WESTERN NEW YORK CENTER FOR THE VISUALLY IMPAIRED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-839-2218
Mailing Address - Street 1:3070 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2584
Mailing Address - Country:US
Mailing Address - Phone:716-668-1166
Mailing Address - Fax:716-668-1466
Practice Address - Street 1:3070 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2584
Practice Address - Country:US
Practice Address - Phone:716-668-1166
Practice Address - Fax:716-668-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5358152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1025Medicare PIN