=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033718549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARK SHER OPTICAL CO OF BUFFALO NY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2020
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6624 LINCOLN AVE
-----------------------------------------------------
City | LOCKPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14094-6109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-433-8235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3035 GENESEE ST
-----------------------------------------------------
City | CHEEKTOWAGA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14225-2661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OD
-----------------------------------------------------
Name | ROBERT JUDE JOBA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-947-2462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------