Healthcare Provider Details

I. General information

NPI: 1215077979
Provider Name (Legal Business Name): KWIK VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MIRACLE MILE DR DBA COHENS FASHION OPTICAL
ROCHESTER NY
14623-5862
US

IV. Provider business mailing address

340 MIRACLE MILE DR DBA COHENS FASHION OPTICAL
ROCHESTER NY
14623-5862
US

V. Phone/Fax

Practice location:
  • Phone: 585-475-0250
  • Fax: 585-475-1703
Mailing address:
  • Phone: 585-475-0250
  • Fax: 585-475-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number006383
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number006383
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM K KWIK
Title or Position: PRESIDENT
Credential: O.D.
Phone: 585-281-0321