Provider Demographics
NPI:1922136464
Name:LICATA, DAVID S
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:S
Last Name:LICATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8070 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4116
Mailing Address - Country:US
Mailing Address - Phone:716-631-3860
Mailing Address - Fax:
Practice Address - Street 1:8070 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4116
Practice Address - Country:US
Practice Address - Phone:716-631-3860
Practice Address - Fax:716-631-3860
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004881-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000300065003OtherBLUE CROSS/BLUE SHIELD
NY333691OtherNVA
NY000300065001OtherBLUE CROSS/BLUE SHIELD
NY333541OtherNVA
NY46032OtherSPECTERA
NY46028OtherSPECTERA
NY00026918201OtherUNIVERA
NY7310246OtherINDEPENDENT HEALTH
NY000528441002OtherCOMMUNITY BLUE
NYOP2234-01OtherEYEMED
NYOP2234-02OtherEYEMED
NY0007025821OtherAETNA
NY7310246OtherINDEPENDENT HEALTH
NY46032OtherSPECTERA