Healthcare Provider Details

I. General information

NPI: 1326069501
Provider Name (Legal Business Name): HENRIETTA OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 E HENRIETTA RD
ROCHESTER NY
14623-4518
US

IV. Provider business mailing address

2116 E HENRIETTA RD
ROCHESTER NY
14623-4518
US

V. Phone/Fax

Practice location:
  • Phone: 585-334-2870
  • Fax:
Mailing address:
  • Phone: 585-334-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberCOO2938-1
License Number StateNY

VIII. Authorized Official

Name: MRS. SANDRA M CALL
Title or Position: VICE PRESIDENT
Credential: N/A
Phone: 585-334-2870