Provider Demographics
NPI:1801876420
Name:NEEDHAM, DENNIS JOSEPH (OD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOSEPH
Last Name:NEEDHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OLD MILL RUN
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-5008
Mailing Address - Country:US
Mailing Address - Phone:716-668-4177
Mailing Address - Fax:716-668-4177
Practice Address - Street 1:5430 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2124
Practice Address - Country:US
Practice Address - Phone:716-685-4050
Practice Address - Fax:716-685-2873
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004546-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist