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General NPI Number Information
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NPI Number | 1043649932
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Entity Type | Individual
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Provider Name | WENDY SUE MICCA OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 422 CLINTON AVE S
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City | ROCHESTER
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State | NY
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Zip | 14620-1103
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Country | US
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Telephone | 585-697-5723
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Fax | 585-232-2972
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Provider Business Mailing Address
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Address Line | 19 PEWTER ROCK
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City | WEBSTER
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State | NY
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Zip | 14580
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Country | US
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Telephone | 585-697-5723
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Fax | 595-232-2972
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 006398
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License Number State | NY
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