Provider Demographics
NPI:1568685113
Name:DR. VERRONE AND DR. PETERS, O.D., P.C.
Entity Type:Organization
Organization Name:DR. VERRONE AND DR. PETERS, O.D., P.C.
Other - Org Name:DR. HANKIN AND DR. VERRONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VERRONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-377-7090
Mailing Address - Street 1:2142 PENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526
Mailing Address - Country:US
Mailing Address - Phone:585-377-7090
Mailing Address - Fax:585-377-3155
Practice Address - Street 1:2142 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526
Practice Address - Country:US
Practice Address - Phone:585-377-7090
Practice Address - Fax:585-377-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 332H00000X
NY332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG0184164370OtherBLUE CHOICE
NYP010006260OtherBLUE CHOICE
NY1073620001OtherMEDICARE NSC
NYP010006260OtherDOCTORS HEALTH
NYP010106260OtherBLUE SHIELD
NYP010006260OtherDOCTORS HEALTH
NYG0184164370OtherBLUE CHOICE