Provider Demographics
NPI:1659348225
Name:DEMARIO, J TODD (OD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:TODD
Last Name:DEMARIO
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:6286 OLD LAKE SHORE RD
Mailing Address - Street 2:LOT 4
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9561
Mailing Address - Country:US
Mailing Address - Phone:716-627-5809
Mailing Address - Fax:
Practice Address - Street 1:6000 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3758
Practice Address - Country:US
Practice Address - Phone:716-648-5761
Practice Address - Fax:716-648-4044
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT6096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU81634Medicare UPIN