Healthcare Provider Details

I. General information

NPI: 1902889538
Provider Name (Legal Business Name): PITTSFORD VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MONROE AVE
ROCHESTER NY
14618-4725
US

IV. Provider business mailing address

3400 MONROE AVE
ROCHESTER NY
14618-4725
US

V. Phone/Fax

Practice location:
  • Phone: 585-383-8320
  • Fax: 585-383-9049
Mailing address:
  • Phone: 585-383-8320
  • Fax: 585-383-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. SAM A TADROS
Title or Position: PRESIDENT
Credential:
Phone: 585-935-1081