MEDICARE: HENRIETTA OPTICAL, INC.

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	156FX1800X	Optician	COO2938-1	NY

General Provider Information

NPI Number	:	1326069501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRIETTA OPTICAL, INC.

Provider Business Mailing Address
First Line	:	2116 E HENRIETTA RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-4518
Country	:	US
Telephone Number	:	585-334-2870
Fax Number	:

Provider Business Practice Location Address
First Line	:	2116 E HENRIETTA RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-4518
Country	:	US
Telephone Number	:	585-334-2870
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. SANDRA M CALL
Credential	:	N/A
Telephone Number	:	585-334-2870

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/22/2020

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