Provider Demographics
NPI:1205119120
Name:GUY, VADIM (OD)
Entity type:Individual
Prefix:DR
First Name:VADIM
Middle Name:
Last Name:GUY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 JEFFERSON RD
Mailing Address - Street 2:FAMILY VISION CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3139
Mailing Address - Country:US
Mailing Address - Phone:585-427-0780
Mailing Address - Fax:585-427-0781
Practice Address - Street 1:1425 JEFFERSON RD
Practice Address - Street 2:FAMILY VISION CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3139
Practice Address - Country:US
Practice Address - Phone:585-427-0780
Practice Address - Fax:585-427-0781
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4642152W00000X
NYTUV007822152W00000X, 152WC0802X, 152WV0400X, 152WS0006X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics