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General NPI Number Information
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NPI Number | 1194959486
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Entity Type | Organization
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Legal Business Name | CVG OPTOMETRY, LLC
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 3171 CHILI AVE SUITE 100
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City | ROCHESTER
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State | NY
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Zip | 14624-5440
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Country | US
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Telephone | 585-889-9693
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Fax | 585-889-3558
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Provider Business Mailing Address
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Address Line | 3171 CHILI AVE SUITE 100
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City | ROCHESTER
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State | NY
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Zip | 14624-5440
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Country | US
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Telephone | 585-889-9693
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Fax | 585-889-3558
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ERICA M MARCIANO
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Credential |
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Telephone | 585-889-9693
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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 | TUV005201
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV005201
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License Number State | NY
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