MEDICARE: THE OPTICAL STORE

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1922155027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OPTICAL STORE

Provider Business Mailing Address
First Line	:	3750 DELAWARE AVE
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-1002
Country	:	US
Telephone Number	:	716-874-4554
Fax Number	:	716-874-4555

Provider Business Practice Location Address
First Line	:	3750 DELAWARE AVE
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-1002
Country	:	US
Telephone Number	:	716-874-4554
Fax Number	:	716-874-4555

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MARIA L GALLA
Credential	:
Telephone Number	:	716-874-4554

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

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Practice Location Address:

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14217-1002

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Practice Location Address:

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1316065733 — DR. ARLETTE TUCCI KIRK D.D.S.
Practice Location Address:

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1073055745 — DR. RAFFAELLA MARIA MARCANTONIO N.D.
Practice Location Address:

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Directions to “THE OPTICAL STORE ” Practice Location

Language	Start Address	Practice Location

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