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General NPI Number Information
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NPI Number | 1033304597
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Entity Type | Organization
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Legal Business Name | LEGARRETA EYE CENTER
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 1301 N FOREST RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3277
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Country | US
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Telephone | 716-633-2203
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Fax | 716-633-7738
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Provider Business Mailing Address
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Address Line | 1301 N FOREST RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3277
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Country | US
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Telephone | 716-633-2203
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Fax | 716-633-7738
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Authorized Official
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Title or Position | OPHTHALMOGIST/OWNER OF PRACTICE
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Name | DR. EDWARD ANDREW LEGARRETA
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Credential | M.D.
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Telephone | 716-668-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 124124
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License Number State | NY
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