Provider Demographics
NPI:1295789485
Name:SCERRA, CHESTER ALBERT (OD)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:ALBERT
Last Name:SCERRA
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 1:1059 LARKSTON DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8621
Mailing Address - Country:US
Mailing Address - Phone:585-872-0297
Mailing Address - Fax:
Practice Address - Street 1:603 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522-1172
Practice Address - Country:US
Practice Address - Phone:315-502-0072
Practice Address - Fax:315-502-0031
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV4556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU42282Medicare UPIN
NYDD6821Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NYRB3535Medicare PIN
NYDD6821Medicare PIN