Healthcare Provider Details

I. General information

NPI: 1053691733
Provider Name (Legal Business Name): AHLAM P CHAUDHRY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 SHERIDAN DR
TONAWANDA NY
14150-9419
US

IV. Provider business mailing address

S3840 MCKINLEY PARKWAY
BLASDELL NY
14219
US

V. Phone/Fax

Practice location:
  • Phone: 716-822-1000
  • Fax:
Mailing address:
  • Phone: 716-822-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002531
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOEG002531
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOEG002531
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: