Provider Demographics
NPI:1982691101
Name:TOWN PARK OPTICAL
Entity Type:Organization
Organization Name:TOWN PARK OPTICAL
Other - Org Name:OPTICAL STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEPKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-893-0633
Mailing Address - Street 1:2507 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4527
Mailing Address - Country:US
Mailing Address - Phone:716-893-0633
Mailing Address - Fax:716-893-0633
Practice Address - Street 1:2507 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4527
Practice Address - Country:US
Practice Address - Phone:716-893-0633
Practice Address - Fax:716-893-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2306156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0852620001Medicare ID - Type Unspecified