Healthcare Provider Details

I. General information

NPI: 1568685113
Provider Name (Legal Business Name): DR. VERRONE AND DR. PETERS, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 PENFIELD RD
PENFIELD NY
14526
US

IV. Provider business mailing address

2142 PENFIELD RD
PENFIELD NY
14526
US

V. Phone/Fax

Practice location:
  • Phone: 585-377-7090
  • Fax: 585-377-3155
Mailing address:
  • Phone: 585-377-7090
  • Fax: 585-377-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNY

VIII. Authorized Official

Name: JUSTIN JOSEPH VERRONE
Title or Position: CEO
Credential: O.D.
Phone: 585-377-7090