Provider Demographics
NPI:1437352192
Name:BROCKPORT OPTOMETRY, PC
Entity Type:Organization
Organization Name:BROCKPORT OPTOMETRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RAFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-637-2121
Mailing Address - Street 1:38 FARM FIELD LN
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2865
Mailing Address - Country:US
Mailing Address - Phone:585-248-2141
Mailing Address - Fax:
Practice Address - Street 1:22 N MAIN ST
Practice Address - Street 2:LOWER SUITE
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1614
Practice Address - Country:US
Practice Address - Phone:585-637-2121
Practice Address - Fax:585-637-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14106BMedicare PIN
NYT25904Medicare UPIN