Provider Demographics
NPI:1669599247
Name:DAVISON ROAD OPTICAL INC
Entity type:Organization
Organization Name:DAVISON ROAD OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-434-8063
Mailing Address - Street 1:2731 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-1203
Mailing Address - Country:US
Mailing Address - Phone:716-778-0926
Mailing Address - Fax:716-778-0926
Practice Address - Street 1:2731 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-1203
Practice Address - Country:US
Practice Address - Phone:716-778-0926
Practice Address - Fax:716-778-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY149010OtherCOLE
NYNY3149OtherEYEMED LOCATION #
NY000300233002OtherBC-BS
NY0005901355OtherAETNA GROUP #
NY145817COtherPREFFERED CARE
NY1071OtherUNIVERA PIN #
NY330868OtherNVA
NYOS0044759OtherINDEPENDENT HEALTH RX #
NY1071OtherUNIVERA PIN #