Healthcare Provider Details

I. General information

NPI: 1275666190
Provider Name (Legal Business Name): WESTERN NEW YORK CENTER FOR THE VISUALLY IMPAIRED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 TRANSIT RD
WEST SENECA NY
14224-2584
US

IV. Provider business mailing address

3070 TRANSIT RD
WEST SENECA NY
14224-2584
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-1166
  • Fax: 716-668-1466
Mailing address:
  • Phone: 716-668-1166
  • Fax: 716-668-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number5358
License Number StateNY

VIII. Authorized Official

Name: DR. JOHN RUNDQUIST
Title or Position: EXECUTIVE DIRECTOR
Credential: O.D.
Phone: 716-839-2218