Healthcare Provider Details

I. General information

NPI: 1538583356
Provider Name (Legal Business Name): OCULOFACIAL PLASTIC SURGERY OF WNY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 MAIN ST
WILLIAMSVILLE NY
14221-8220
US

IV. Provider business mailing address

5800 MAIN ST
WILLIAMSVILLE NY
14221-8220
US

V. Phone/Fax

Practice location:
  • Phone: 315-256-8826
  • Fax:
Mailing address:
  • Phone: 315-256-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number242642
License Number StateNY

VIII. Authorized Official

Name: PETER EMMETT HURLEY
Title or Position: SOLE PROVIDER
Credential: MD
Phone: 716-512-1617