Provider Demographics
NPI:1962479949
Name:UNIVERSITY OPTICAL CORP
Entity Type:Organization
Organization Name:UNIVERSITY OPTICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-786-8505
Mailing Address - Street 1:2469 STATE ROUTE 19 N
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-9336
Mailing Address - Country:US
Mailing Address - Phone:585-786-8505
Mailing Address - Fax:585-786-8490
Practice Address - Street 1:2469 STATE ROUTE 19 N
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9336
Practice Address - Country:US
Practice Address - Phone:585-786-8505
Practice Address - Fax:585-786-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011258003OtherUNIVERA HEALTHCARE BUFFAL
NYOP1387OtherEYEMED/INDEPENDENT HEALTH
NY106386CTOtherPREFERRED CARE
NYP017157362OtherBCBS ROCHESTER
NY0005177624OtherAETNA
NY0331120006Medicare NSC
NY0331120003Medicare NSC
NYOP1387OtherEYEMED/INDEPENDENT HEALTH
NY106386CTOtherPREFERRED CARE
NY0331120005Medicare NSC