Healthcare Provider Details

I. General information

NPI: 1205861176
Provider Name (Legal Business Name): AKRON OPTICAL SHOP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAIN ST
AKRON NY
14001-1239
US

IV. Provider business mailing address

55 MAIN ST
AKRON NY
14001-1239
US

V. Phone/Fax

Practice location:
  • Phone: 716-542-2002
  • Fax:
Mailing address:
  • Phone: 716-542-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT004942
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT002702-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number006922-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005016-1
License Number StateNY

VIII. Authorized Official

Name: MS. GINA LEE SAROW
Title or Position: OWNER
Credential:
Phone: 716-542-2002