Healthcare Provider Details

I. General information

NPI: 1235602475
Provider Name (Legal Business Name): TERESE CIMINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5033 TRANSIT RD
WILLIAMSVILLE NY
14221-4132
US

IV. Provider business mailing address

5033 TRANSIT RD
WILLIAMSVILLE NY
14221-4132
US

V. Phone/Fax

Practice location:
  • Phone: 716-565-0261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number009795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: