Provider Demographics
NPI:1417573411
Name:WNY SOUTHTOWNS OPTOMETRY PLLC
Entity Type:Organization
Organization Name:WNY SOUTHTOWNS OPTOMETRY PLLC
Other - Org Name:716 EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-493-0521
Mailing Address - Street 1:3 CLAUDIA CT
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-2331
Mailing Address - Country:US
Mailing Address - Phone:901-493-0521
Mailing Address - Fax:
Practice Address - Street 1:112 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-2149
Practice Address - Country:US
Practice Address - Phone:901-493-0521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty