Healthcare Provider Details

I. General information

NPI: 1619906252
Provider Name (Legal Business Name): ROCHESTER EYE ASSOCIATES PHYSICIANS AND SURGEONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LAC DE VILLE BLVD
ROCHESTER NY
14618-5646
US

IV. Provider business mailing address

2301 LAC DE VILLE BLVD
ROCHESTER NY
14618-5646
US

V. Phone/Fax

Practice location:
  • Phone: 585-244-0332
  • Fax: 585-473-8833
Mailing address:
  • Phone: 585-244-0332
  • Fax: 585-473-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT L OLSEN
Title or Position: PRESIDENT
Credential: MD
Phone: 585-244-0332