Provider Demographics
NPI:1710100581
Name:EYE CARE AND VISION ASSOCIATES OPHTHALMOLOGY, LLP
Entity Type:Organization
Organization Name:EYE CARE AND VISION ASSOCIATES OPHTHALMOLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-648-5329
Mailing Address - Street 1:3712 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1720
Mailing Address - Country:US
Mailing Address - Phone:716-648-5329
Mailing Address - Fax:716-648-3815
Practice Address - Street 1:3712 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1720
Practice Address - Country:US
Practice Address - Phone:716-648-5329
Practice Address - Fax:716-648-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01799206Medicaid
NY14337AMedicare ID - Type Unspecified
NY1185730004Medicare NSC