Provider Demographics
NPI:1609013382
Name:ROBERT W. RADAU, OPTICIAN, P.C.
Entity Type:Organization
Organization Name:ROBERT W. RADAU, OPTICIAN, P.C.
Other - Org Name:ELMWOOD SPECS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RADAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-883-9855
Mailing Address - Street 1:1006 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1202
Mailing Address - Country:US
Mailing Address - Phone:716-883-9855
Mailing Address - Fax:716-883-9755
Practice Address - Street 1:1006 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1202
Practice Address - Country:US
Practice Address - Phone:716-883-9855
Practice Address - Fax:716-883-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC007296332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4705110001Medicare NSC