Provider Demographics
NPI:1922181080
Name:GOWANDA EYE CARE, INC.
Entity Type:Organization
Organization Name:GOWANDA EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:716-532-2396
Mailing Address - Street 1:4 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1208
Mailing Address - Country:US
Mailing Address - Phone:716-532-2396
Mailing Address - Fax:716-532-2701
Practice Address - Street 1:4 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1208
Practice Address - Country:US
Practice Address - Phone:716-532-2396
Practice Address - Fax:716-532-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004749-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4414140001Medicare ID - Type UnspecifiedPROVIDER ID NUMBER