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General NPI Number Information
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NPI Number | 1386750974
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Entity Type | Organization
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Legal Business Name | COUNCIL OPTICIANS OF BATAVIA INC.
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 216 E MAIN ST
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City | BATAVIA
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State | NY
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Zip | 14020-2221
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Country | US
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Telephone | 585-343-0633
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Fax | 585-343-0211
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Provider Business Mailing Address
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Address Line | 216 E MAIN ST
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City | BATAVIA
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State | NY
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Zip | 14020-2221
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Country | US
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Telephone | 585-343-0633
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Fax | 585-343-0211
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT E GOUINLOCK
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Credential | OD
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Telephone | 585-343-0633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | NYT005845
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License Number State | NY
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