Provider Demographics
NPI:1760530091
Name:MARY E VADAS, OD, LLC
Entity Type:Organization
Organization Name:MARY E VADAS, OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:VADAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-349-3300
Mailing Address - Street 1:2277 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2225
Mailing Address - Country:US
Mailing Address - Phone:585-349-3300
Mailing Address - Fax:585-349-3336
Practice Address - Street 1:2277 S UNION ST
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-2225
Practice Address - Country:US
Practice Address - Phone:585-349-3300
Practice Address - Fax:585-349-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB4298Medicare UPIN