Provider Demographics
NPI:1376924944
Name:4-KIDS OPTICAL
Entity Type:Organization
Organization Name:4-KIDS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-204-4519
Mailing Address - Street 1:3980 SHERIDAN DRIVE SUITE 402
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-362-0651
Mailing Address - Fax:716-204-4519
Practice Address - Street 1:3980 SHERIDAN DRIVE SUITE 402
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-362-0651
Practice Address - Fax:716-204-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier