Provider Demographics
NPI:1578595039
Name:JAUCH, RICHARD (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:JAUCH
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 1:4050 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1646
Mailing Address - Country:US
Mailing Address - Phone:716-675-6100
Mailing Address - Fax:716-675-6101
Practice Address - Street 1:4050 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1646
Practice Address - Country:US
Practice Address - Phone:716-675-6100
Practice Address - Fax:716-675-6101
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC002892-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0163240001Medicare NSC