Healthcare Provider Details

I. General information

NPI: 1609980879
Provider Name (Legal Business Name): OPHTHALMOLOGY ASSOCIATES OF WESTERN NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 MAIN ST
WILLIAMSVILLE NY
14221-5800
US

IV. Provider business mailing address

6333 MAIN ST
WILLIAMSVILLE NY
14221-5800
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-3545
  • Fax: 716-632-6368
Mailing address:
  • Phone: 716-632-3545
  • Fax: 716-632-6368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES R NILES
Title or Position: PRESIDENT
Credential: MD
Phone: 716-632-3545