Healthcare Provider Details

I. General information

NPI: 1780972786
Provider Name (Legal Business Name): PACER OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HOLT RD # 10
WEBSTER NY
14580-9102
US

IV. Provider business mailing address

900 HOLT RD SPC 10
WEBSTER NY
14580-9102
US

V. Phone/Fax

Practice location:
  • Phone: 585-872-4006
  • Fax: 585-872-4021
Mailing address:
  • Phone: 585-872-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberC004816-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5361
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC004816-1
License Number StateNY

VIII. Authorized Official

Name: MRS. LESLIE M PACER
Title or Position: MEMBER/MANAGING OPTICIAN
Credential:
Phone: 585-872-4006