MEDICARE: DIANE FLANIGEN MD EYE CARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	178565	NY

General Provider Information

NPI Number	:	1215105101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANE FLANIGEN MD EYE CARE PC

Provider Business Mailing Address
First Line	:	908 NIAGARA FALLS BLVD
Second Line	:	SUITE 208
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2019
Country	:	US
Telephone Number	:	716-692-3302
Fax Number	:	716-362-9518

Provider Business Practice Location Address
First Line	:	1835 MAPLE RD
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-2780
Country	:	US
Telephone Number	:	716-631-2900
Fax Number	:	716-631-2903

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DR. DIANE THERESE FLANIGEN
Credential	:	MD
Telephone Number	:	716-631-2900

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	10/01/2008

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