Provider Demographics
NPI:1609099563
Name:CREIGHTON OPTICAL
Entity Type:Organization
Organization Name:CREIGHTON OPTICAL
Other - Org Name:JAMES F. CREIGHTON, OPTICIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-937-7373
Mailing Address - Street 1:13375 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1410
Mailing Address - Country:US
Mailing Address - Phone:716-937-7373
Mailing Address - Fax:716-937-4136
Practice Address - Street 1:13375 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1410
Practice Address - Country:US
Practice Address - Phone:716-937-7373
Practice Address - Fax:716-937-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUT003462152W00000X
NYV0048731152W00000X
NY3610152W00000X
NY2738156FX1800X
NY6357156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0209720001Medicare NSC