Healthcare Provider Details

I. General information

NPI: 1093775892
Provider Name (Legal Business Name): WESTFIELD OPTICAL STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E MAIN ST
WESTFIELD NY
14787-1306
US

IV. Provider business mailing address

105 E MAIN ST
WESTFIELD NY
14787-1306
US

V. Phone/Fax

Practice location:
  • Phone: 716-793-2020
  • Fax: 716-793-3030
Mailing address:
  • Phone: 716-793-2020
  • Fax: 716-793-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number0050451
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARLENE GOLIBERSUCH
Title or Position: OWNER
Credential:
Phone: 716-793-2020