Healthcare Provider Details

I. General information

NPI: 1699940858
Provider Name (Legal Business Name): LPEC MEDICAL EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ERIE ST
MEDINA NY
14103-1010
US

IV. Provider business mailing address

500 ERIE ST
MEDINA NY
14103-1010
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-2020
  • Fax: 585-798-3365
Mailing address:
  • Phone: 585-798-2020
  • Fax: 585-798-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number006723
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number120403
License Number StateNY

VIII. Authorized Official

Name: DR. ARTHUR W MRUCZEK SR.
Title or Position: OWNER
Credential: MD
Phone: 585-798-2020