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NPI Code Detail

MEDICARE: EYES ON HARLEM

MEDICARE: EYES ON HARLEM
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
1332H00000XEyewear Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000300015004OTHERNYBLUE CROSS/BLUE SHIELD OF WESTERN NEW YORK

General Provider Information

NPI Number : 1831531599
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYES ON HARLEM
Provider Business Mailing Address
First Line : 2507 HARLEM RD
Second Line :
City : CHEEKTOWAGA
State : NY
Zip : 14225-4527
Country : US
Telephone Number : 716-893-0633
Fax Number : 716-893-0633
Provider Business Practice Location Address
First Line : 2507 HARLEM RD
Second Line :
City : CHEEKTOWAGA
State : NY
Zip : 14225-4527
Country : US
Telephone Number : 716-893-0633
Fax Number : 716-893-0633
Authorized Official
Title or Position : MANAGER
Name : MS. LISA CUDMORE
Credential :
Telephone Number : 716-893-0633
Provider Enumeration Date : 07/23/2013
Last Update Date : 07/23/2013

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Directions to “EYES ON HARLEM ” Practice Location

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