Provider Demographics
NPI:1659779338
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:
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-695-3733
Mailing Address - Street 1:642 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-7853
Mailing Address - Country:US
Mailing Address - Phone:716-695-3733
Mailing Address - Fax:716-646-3926
Practice Address - Street 1:642 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-7853
Practice Address - Country:US
Practice Address - Phone:716-695-3733
Practice Address - Fax:716-646-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007272152W00000X
NY07272156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty