Healthcare Provider Details

I. General information

NPI: 1437087582
Provider Name (Legal Business Name): EVAN HERBOLD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1720
US

IV. Provider business mailing address

2351 W BLOOD RD
EAST AURORA NY
14052-1123
US

V. Phone/Fax

Practice location:
  • Phone: 716-648-5329
  • Fax:
Mailing address:
  • Phone: 716-946-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011414
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: