Provider Demographics
NPI:1639144058
Name:COUNCIL OPTICIANS OF NIAGARA FALLS
Entity Type:Organization
Organization Name:COUNCIL OPTICIANS OF NIAGARA FALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TRZEPKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-298-8182
Mailing Address - Street 1:7600 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1842
Mailing Address - Country:US
Mailing Address - Phone:716-298-8182
Mailing Address - Fax:716-298-0710
Practice Address - Street 1:7600 3RD AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1842
Practice Address - Country:US
Practice Address - Phone:716-298-8182
Practice Address - Fax:716-298-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUT005607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU53557Medicare UPIN