Provider Demographics
NPI:1295949311
Name:BROADWAY OPTICIANS
Entity type:Organization
Organization Name:BROADWAY OPTICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOSZCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DISPENSING OPTICIAN
Authorized Official - Phone:716-892-9373
Mailing Address - Street 1:999 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-1369
Mailing Address - Country:US
Mailing Address - Phone:716-892-9373
Mailing Address - Fax:716-892-8316
Practice Address - Street 1:999 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1369
Practice Address - Country:US
Practice Address - Phone:716-892-9373
Practice Address - Fax:716-892-8316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5635-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01343728Medicaid
NYNY5635OtherEYEMED
NY49661OtherDAVIS VISION
NY00011278301OtherBCBS OG WNY INC
NY000390186005OtherBCBS OF WNY
NY140943OtherCOLE