Provider Demographics
NPI:1831284025
Name:JOHN, PAULA L
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:L
Last Name:JOHN
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 1:3995 BUCKTOOTH RUN RD
Mailing Address - Street 2:PRIVATE EYES OPTICAL
Mailing Address - City:LITTLE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14755-9414
Mailing Address - Country:US
Mailing Address - Phone:716-307-7435
Mailing Address - Fax:716-945-2031
Practice Address - Street 1:3995 BUCKTOOTH RUN RD
Practice Address - Street 2:PRIVATE EYES OPTICAL
Practice Address - City:LITTLE VALLEY
Practice Address - State:NY
Practice Address - Zip Code:14755-9414
Practice Address - Country:US
Practice Address - Phone:716-307-7435
Practice Address - Fax:716-945-2031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC005176156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician