Healthcare Provider Details

I. General information

NPI: 1104810845
Provider Name (Legal Business Name): JOSEPH C BIONDOLILLO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 LAKE ST
HAMBURG NY
14075-4471
US

IV. Provider business mailing address

206 LAKE ST
HAMBURG NY
14075-4471
US

V. Phone/Fax

Practice location:
  • Phone: 716-649-1010
  • Fax: 716-649-1382
Mailing address:
  • Phone: 716-649-1010
  • Fax: 716-649-1382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV0038391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: