Provider Demographics
NPI:1629249180
Name:PETER J. VISHTON OD
Entity Type:Organization
Organization Name:PETER J. VISHTON OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:VISHTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-968-2210
Mailing Address - Street 1:26 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1115
Mailing Address - Country:US
Mailing Address - Phone:585-968-2210
Mailing Address - Fax:856-627-2020
Practice Address - Street 1:26 GENESEE ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1115
Practice Address - Country:US
Practice Address - Phone:585-968-2210
Practice Address - Fax:856-627-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0035251332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0433900001Medicare NSC