Provider Demographics
NPI:1609050350
Name:COUNCIL OPTICIANS OF WEST SENECA
Entity Type:Organization
Organization Name:COUNCIL OPTICIANS OF WEST SENECA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-674-8300
Mailing Address - Street 1:3768 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3433
Mailing Address - Country:US
Mailing Address - Phone:716-674-8300
Mailing Address - Fax:716-674-8302
Practice Address - Street 1:3768 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3433
Practice Address - Country:US
Practice Address - Phone:716-674-8300
Practice Address - Fax:716-674-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0269410001Medicare NSC
NY048365Medicare PIN