Healthcare Provider Details

I. General information

NPI: 1932220100
Provider Name (Legal Business Name): DAVID ERWIN GERSTNER OPHTHALMIC DISPENSER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 ORCHARD PARK RD
WEST SENECA NY
14224-4624
US

IV. Provider business mailing address

4201 REGENTS PARK
HAMBURG NY
14075-1344
US

V. Phone/Fax

Practice location:
  • Phone: 716-674-8446
  • Fax: 716-674-3234
Mailing address:
  • Phone: 716-674-8446
  • Fax: 716-674-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number2960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: