Provider Demographics
NPI:1326161035
Name:DAVISON ROAD OPTICAL, INC.
Entity Type:Organization
Organization Name:DAVISON ROAD OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-434-8063
Mailing Address - Street 1:500 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4021
Mailing Address - Country:US
Mailing Address - Phone:716-434-8063
Mailing Address - Fax:716-434-2845
Practice Address - Street 1:500 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-4021
Practice Address - Country:US
Practice Address - Phone:716-434-8063
Practice Address - Fax:716-434-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY3149OtherEYEMED GROUP NO.
NYUNIVERAOther00026473001
NY000300233002OtherBCBS PROVIDER ID
NY330867OtherNVA
NY7212222OtherINDEPENDENT HEALTH
NY149010OtherCOLE
NY0005901355OtherAETNA GROUP
NY106166CSOtherPREFERRED CARE
NY149010OtherCOLE
NY149010OtherCOLE
NY000300233002OtherBCBS PROVIDER ID