Provider Demographics
NPI:1477636538
Name:NASCA, MICHAEL ANTHONY (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:NASCA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3210
Mailing Address - Country:US
Mailing Address - Phone:716-876-2010
Mailing Address - Fax:716-876-2010
Practice Address - Street 1:2138 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-3210
Practice Address - Country:US
Practice Address - Phone:716-876-2010
Practice Address - Fax:716-876-2010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY4126156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0586250001OtherDELAWARE OPTICIANS