Healthcare Provider Details

I. General information

NPI: 1093810830
Provider Name (Legal Business Name): EYESIGHT OPHTHALMOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 DELAWARE AVE SUITE 100
TONAWANDA NY
14150-6850
US

IV. Provider business mailing address

4041 DELAWARE AVE SUITE 100
TONAWANDA NY
14150-6850
US

V. Phone/Fax

Practice location:
  • Phone: 716-837-5200
  • Fax: 716-837-8750
Mailing address:
  • Phone: 716-837-5200
  • Fax: 716-837-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number205998
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS A STATHOPOULOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 716-517-0680