MEDICARE: MID-CITY OPTICIANS

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	156FC0801X	Contact Lens Fitter	C003847	NY
2	156FX1800X	Optician	C003847	NY
3	332H00000X	Eyewear Supplier	3847	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NY3847	OTHER	NY	EYEMED

General Provider Information

NPI Number	:	1225168990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-CITY OPTICIANS

Provider Business Mailing Address
First Line	:	968 PAYNE AVE
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-3234
Country	:	US
Telephone Number	:	716-692-5480
Fax Number	:	716-692-4010

Provider Business Practice Location Address
First Line	:	968 PAYNE AVE
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-3234
Country	:	US
Telephone Number	:	716-692-5480
Fax Number	:	716-692-4010

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MR. ROSS H FOLMSBEE
Credential	:	OPTICIAN
Telephone Number	:	716-692-5480

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	10/29/2009

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Directions to “MID-CITY OPTICIANS ” Practice Location

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