Healthcare Provider Details

I. General information

NPI: 1063485381
Provider Name (Legal Business Name): PAUL S. DELANGE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 EAST AVE
LOCKPORT NY
14094-3812
US

IV. Provider business mailing address

215 EAST AVE
LOCKPORT NY
14094-3812
US

V. Phone/Fax

Practice location:
  • Phone: 716-433-6326
  • Fax: 716-434-7809
Mailing address:
  • Phone: 716-434-2874
  • Fax: 716-434-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV003342-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: