Provider Demographics
NPI:1811200116
Name:BIONDOLILLO EYE CARE LLC
Entity Type:Organization
Organization Name:BIONDOLILLO EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:BIONDOLILLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-649-1010
Mailing Address - Street 1:206 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4471
Mailing Address - Country:US
Mailing Address - Phone:716-649-1010
Mailing Address - Fax:716-649-1382
Practice Address - Street 1:206 LAKE ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4471
Practice Address - Country:US
Practice Address - Phone:716-649-1010
Practice Address - Fax:716-649-1382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0038391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100035957Medicare PIN
NY6602730001Medicare NSC
NYDR3181Medicare PIN