Provider Demographics
NPI:1619085958
Name:PARK SHER OPTICAL CO OF BUFFALO NY INC
Entity Type:Organization
Organization Name:PARK SHER OPTICAL CO OF BUFFALO NY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-668-0711
Mailing Address - Street 1:2305 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1447
Mailing Address - Country:US
Mailing Address - Phone:716-668-0711
Mailing Address - Fax:716-668-0835
Practice Address - Street 1:2305 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1447
Practice Address - Country:US
Practice Address - Phone:716-668-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY49895OtherDAVISVISION
NY000300013003OtherBLUE CROSS & BLUE SHIELD
NY0061482OtherGROUP HEALTH INCORPORATED
NY330421OtherNATIONAL VISION ADMINISTR