Provider Demographics
NPI:1891467486
Name:WESTERN NEW YORK MEDICAL PRACTICE, P.C.
Entity Type:Organization
Organization Name:WESTERN NEW YORK MEDICAL PRACTICE, P.C.
Other - Org Name:ROCHESTER REGIONAL HEALTH EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - PAYER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-0293
Mailing Address - Street 1:2301 LAC DE VILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5646
Mailing Address - Country:US
Mailing Address - Phone:585-244-0332
Mailing Address - Fax:
Practice Address - Street 1:2301 LAC DE VILLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5646
Practice Address - Country:US
Practice Address - Phone:585-244-0332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN NEW YORK MEDICAL PRACTICE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty