Healthcare Provider Details

I. General information

NPI: 1831175090
Provider Name (Legal Business Name): PARK SHER OPTICAL CO OF BUFFALO NY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 DELAWARE AVE
BUFFALO NY
14202-1801
US

IV. Provider business mailing address

280 DELAWARE AVE
BUFFALO NY
14202-1801
US

V. Phone/Fax

Practice location:
  • Phone: 716-854-1620
  • Fax: 716-854-1623
Mailing address:
  • Phone: 716-770-5980
  • Fax: 716-219-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberTUV004737-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number003195
License Number StateNY

VIII. Authorized Official

Name: ROBERT JUDE JOBA
Title or Position: OD
Credential:
Phone: 716-947-2462