Provider Demographics
NPI:1346464351
Name:COUNCIL OPTICIANS OF TONAWANDA INC
Entity Type:Organization
Organization Name:COUNCIL OPTICIANS OF TONAWANDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD OPTOMETRIST
Authorized Official - Phone:716-695-3733
Mailing Address - Street 1:4244 DELAWARE AVENUE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6120
Mailing Address - Country:US
Mailing Address - Phone:716-695-3733
Mailing Address - Fax:716-695-0112
Practice Address - Street 1:4244 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6120
Practice Address - Country:US
Practice Address - Phone:716-695-3733
Practice Address - Fax:716-695-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYTUV003292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTUV003292OtherLICENSE #
NY00634491Medicaid
NYTUV003292OtherLICENSE #
T87277Medicare UPIN