Provider Demographics
NPI:1982659801
Name:CALHOUN EYE CARE AND OPTOMETRY PC
Entity Type:Organization
Organization Name:CALHOUN EYE CARE AND OPTOMETRY PC
Other - Org Name:ADVANCED EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-631-9970
Mailing Address - Street 1:6622 MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5968
Mailing Address - Country:US
Mailing Address - Phone:716-631-9970
Mailing Address - Fax:716-631-8809
Practice Address - Street 1:5488 SHERIDAN DR STE 300
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3888
Practice Address - Country:US
Practice Address - Phone:716-631-9970
Practice Address - Fax:716-631-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006035152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02534334Medicaid
NY02534334Medicaid
NY5050690001Medicare NSC