Healthcare Provider Details

I. General information

NPI: 1376605295
Provider Name (Legal Business Name): STEVEN IHRIG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E MAIN ST
FREDONIA NY
14063-1409
US

IV. Provider business mailing address

225 E MAIN ST
FREDONIA NY
14063-1409
US

V. Phone/Fax

Practice location:
  • Phone: 716-679-1553
  • Fax: 716-679-3353
Mailing address:
  • Phone: 716-679-1553
  • Fax: 716-679-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTU004293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: