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General NPI Number Information
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NPI Number | 1588752323
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Entity Type | Individual
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Provider Name | RICHARD BARRY KOMM OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2342 NIAGARA FALLS BLVD
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City | TONAWANDA
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State | NY
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Zip | 14150-4759
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Country | US
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Telephone | 716-694-4388
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Fax | 716-694-1140
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Provider Business Mailing Address
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Address Line | 2342 NIAGARA FALLS BLVD
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City | TONAWANDA
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State | NY
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Zip | 14150-4759
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Country | US
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Telephone | 716-694-4388
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Fax | 716-694-1140
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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 | 3610
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License Number State | NY
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