Provider Demographics
NPI:1831181528
Name:EYE HEALTH ASSOCIATES OF WESTERN NEW YORK PC
Entity type:Organization
Organization Name:EYE HEALTH ASSOCIATES OF WESTERN NEW YORK PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-634-6100
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-0807
Mailing Address - Country:US
Mailing Address - Phone:716-634-6100
Mailing Address - Fax:716-204-9084
Practice Address - Street 1:170 MAPLE ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2930
Practice Address - Country:US
Practice Address - Phone:716-634-6100
Practice Address - Fax:716-204-9084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE HEALTH ASSOCIATES OF WESTERN NEW YORK PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-18
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002258051Medicaid
005258815OtherBLUE CROSS/BLUE SHIELD
NY002258051Medicaid