Provider Demographics
NPI:1609980879
Name:OPHTHALMOLOGY ASSOCIATES OF WESTERN NEW YORK PC
Entity Type:Organization
Organization Name:OPHTHALMOLOGY ASSOCIATES OF WESTERN NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-632-3545
Mailing Address - Street 1:6333 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5800
Mailing Address - Country:US
Mailing Address - Phone:716-632-3545
Mailing Address - Fax:716-632-6368
Practice Address - Street 1:6333 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5800
Practice Address - Country:US
Practice Address - Phone:716-632-3545
Practice Address - Fax:716-632-6368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0920260001Medicare NSC
NY020523Medicare ID - Type Unspecified