Healthcare Provider Details

I. General information

NPI: 1215105101
Provider Name (Legal Business Name): DIANE FLANIGEN MD EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 MAPLE RD
WILLIAMSVILLE NY
14221-2780
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD SUITE 208
NORTH TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-2900
  • Fax: 716-631-2903
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-362-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number178565
License Number StateNY

VIII. Authorized Official

Name: DR. DIANE THERESE FLANIGEN
Title or Position: OWNER/CEO
Credential: MD
Phone: 716-631-2900