Provider Demographics
NPI:1659842235
Name:MIODONSKI, CATHY LYNN
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:LYNN
Last Name:MIODONSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4738
Mailing Address - Country:US
Mailing Address - Phone:716-896-5217
Mailing Address - Fax:716-681-4249
Practice Address - Street 1:2500 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4738
Practice Address - Country:US
Practice Address - Phone:716-896-5217
Practice Address - Fax:716-681-4249
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6905-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician