Healthcare Provider Details

I. General information

NPI: 1194959486
Provider Name (Legal Business Name): CVG OPTOMETRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3171 CHILI AVE SUITE 100
ROCHESTER NY
14624-5440
US

IV. Provider business mailing address

3171 CHILI AVE SUITE 100
ROCHESTER NY
14624-5440
US

V. Phone/Fax

Practice location:
  • Phone: 585-889-9693
  • Fax: 585-889-3558
Mailing address:
  • Phone: 585-889-9693
  • Fax: 585-889-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005201
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberTUV005201
License Number StateNY

VIII. Authorized Official

Name: MRS. ERICA M MARCIANO
Title or Position: OFFICE MANAGER
Credential:
Phone: 585-889-9693