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General NPI Number Information
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NPI Number | 1093810830
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Entity Type | Organization
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Legal Business Name | EYESIGHT OPHTHALMOLOGY P.C.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 4041 DELAWARE AVE SUITE 100
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City | TONAWANDA
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State | NY
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Zip | 14150-6850
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Country | US
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Telephone | 716-837-5200
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Fax | 716-837-8750
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Provider Business Mailing Address
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Address Line | 4041 DELAWARE AVE SUITE 100
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City | TONAWANDA
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State | NY
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Zip | 14150-6850
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Country | US
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Telephone | 716-837-5200
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Fax | 716-837-8750
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICHOLAS A STATHOPOULOS
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Credential | M.D.
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Telephone | 716-517-0680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 205998
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License Number State | NY
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