Provider Demographics
NPI:1013629377
Name:BUFFALO OPTIQUE LLC
Entity Type:Organization
Organization Name:BUFFALO OPTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYNIARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:716-633-7386
Mailing Address - Street 1:5014ROCKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031
Mailing Address - Country:US
Mailing Address - Phone:716-633-7386
Mailing Address - Fax:
Practice Address - Street 1:301 STERLING DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1570
Practice Address - Country:US
Practice Address - Phone:716-671-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service