Provider Demographics
NPI:1508989211
Name:DAVISON ROAD OPTICAL, INC.
Entity Type:Organization
Organization Name:DAVISON ROAD OPTICAL, INC.
Other - Org Name:NEWFANE FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-434-8063
Mailing Address - Street 1:500 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4021
Mailing Address - Country:US
Mailing Address - Phone:716-778-0926
Mailing Address - Fax:716-778-0926
Practice Address - Street 1:2731 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-1203
Practice Address - Country:US
Practice Address - Phone:716-778-0926
Practice Address - Fax:716-778-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106166CSOtherPREFERRED CARE
NYNY3149OtherEYEMED
NY000300233002OtherBCBS PROVIDER ID
NY7212222OtherINDEPENDENT HEALTH
NY00026473001OtherUNIVERA
NY330867OtherNVA
NY0005901355OtherAETNA
NY330867OtherNVA
NYNY3149OtherEYEMED
NY7212222OtherINDEPENDENT HEALTH