Healthcare Provider Details

I. General information

NPI: 1194791780
Provider Name (Legal Business Name): PARK SHER OPTICAL CO OF BUFFALO NY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 RIDGE RD
WEBSTER NY
14580-2568
US

IV. Provider business mailing address

950 RIDGE RD
WEBSTER NY
14580-2568
US

V. Phone/Fax

Practice location:
  • Phone: 585-671-6630
  • Fax: 585-225-3293
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JUDE JOBA
Title or Position: OD
Credential:
Phone: 716-947-2462