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General NPI Number Information
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NPI Number | 1538583356
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Entity Type | Organization
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Legal Business Name | OCULOFACIAL PLASTIC SURGERY OF WNY PLLC
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 5800 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8220
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Country | US
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Telephone | 315-256-8826
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8220
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Country | US
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Telephone | 315-256-8826
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Fax |
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Authorized Official
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Title or Position | SOLE PROVIDER
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Name | PETER EMMETT HURLEY
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Credential | MD
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Telephone | 716-512-1617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 242642
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License Number State | NY
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