Healthcare Provider Details

I. General information

NPI: 1053464222
Provider Name (Legal Business Name): AKRON VILLAGE OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAIN ST
AKRON NY
14001
US

IV. Provider business mailing address

10 MAIN ST
AKRON NY
14001
US

V. Phone/Fax

Practice location:
  • Phone: 716-542-2110
  • Fax: 716-542-2110
Mailing address:
  • Phone: 716-542-2110
  • Fax: 716-542-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberNY5194
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH POVEROMO
Title or Position: OWNER
Credential: OPTICIAN
Phone: 716-542-2110