Provider Demographics
NPI:1780972786
Name:PACER OPTICAL LLC
Entity type:Organization
Organization Name:PACER OPTICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGING OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PACER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-872-4006
Mailing Address - Street 1:900 HOLT RD SPC 10
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9102
Mailing Address - Country:US
Mailing Address - Phone:585-872-3444
Mailing Address - Fax:
Practice Address - Street 1:900 HOLT RD # 10
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9102
Practice Address - Country:US
Practice Address - Phone:585-872-4006
Practice Address - Fax:585-872-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004816-1156FC0801X, 156FX1800X
NY5361152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty