Provider Demographics
NPI:1912183062
Name:STEPHEN B. POLLACK MD
Entity Type:Organization
Organization Name:STEPHEN B. POLLACK MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LINDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-689-8525
Mailing Address - Street 1:1630 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3706
Mailing Address - Country:US
Mailing Address - Phone:716-689-8525
Mailing Address - Fax:
Practice Address - Street 1:1630 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3706
Practice Address - Country:US
Practice Address - Phone:716-689-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC4681156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00949459Medicaid
NYD01448Medicare UPIN
NY4378860001Medicare NSC