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General NPI Number Information
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NPI Number | 1124248760
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Entity Type | Individual
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Provider Name | CARL RICHARD ENDRES OPTHALMIC DISPENSER
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1777 ORCHARD PARK RD
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City | WEST SENECA
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State | NY
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Zip | 14224-4624
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Country | US
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Telephone | 716-674-8446
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Fax | 716-674-2682
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Provider Business Mailing Address
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Address Line | 5470 ABEL RD
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City | HAMBURG
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State | NY
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Zip | 14075-3641
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Country | US
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Telephone | 716-648-7575
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Fax |
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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 | C003507
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License Number State | NY
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