Provider Demographics
NPI:1932615788
Name:ADEY, DENNIS MICHAEL SR (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:ADEY
Suffix:SR
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 1:10401 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1402
Mailing Address - Country:US
Mailing Address - Phone:716-679-3180
Mailing Address - Fax:
Practice Address - Street 1:10401 BENNETT RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1402
Practice Address - Country:US
Practice Address - Phone:716-679-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5885247200000X
NYC5885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other