Provider Demographics
NPI:1700099785
Name:INTERNICOLA, AMY B (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:B
Last Name:INTERNICOLA
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9405
Mailing Address - Country:US
Mailing Address - Phone:716-836-8700
Mailing Address - Fax:716-836-3549
Practice Address - Street 1:2441 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9405
Practice Address - Country:US
Practice Address - Phone:716-836-8700
Practice Address - Fax:716-836-3549
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC005694-1156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC005694-1OtherLICENSED OPTICIAN