Provider Demographics
NPI:1679667414
Name:COUNCIL OPTICIANS OF LOCKPORT INC
Entity Type:Organization
Organization Name:COUNCIL OPTICIANS OF LOCKPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIANS/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HOHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-433-8235
Mailing Address - Street 1:6624 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-6109
Mailing Address - Country:US
Mailing Address - Phone:716-433-8235
Mailing Address - Fax:716-332-5970
Practice Address - Street 1:6624 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-6109
Practice Address - Country:US
Practice Address - Phone:716-433-8235
Practice Address - Fax:716-332-5970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5150332H00000X
NY006167-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0428060001Medicare NSC
NYBA1143Medicare PIN