Provider Demographics
NPI:1780708867
Name:RICH, MICHAEL ZACHARY (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ZACHARY
Last Name:RICH
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4612
Mailing Address - Country:US
Mailing Address - Phone:585-641-0756
Mailing Address - Fax:585-641-0757
Practice Address - Street 1:3340 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4612
Practice Address - Country:US
Practice Address - Phone:585-641-0756
Practice Address - Fax:585-641-0757
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006305156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician