MEDICARE: JOSEPH S HARGRAVE OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV004999	NY

General Provider Information

NPI Number	:	1306890496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH S HARGRAVE OD PC

Provider Business Mailing Address
First Line	:	PO BOX 1146
Second Line	:
City	:	LEWISTON
State	:	NY
Zip	:	14092-8146
Country	:	US
Telephone Number	:	716-754-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 PORTAGE RD
Second Line	:
City	:	LEWISTON
State	:	NY
Zip	:	14092-1700
Country	:	US
Telephone Number	:	716-754-8816
Fax Number	:	716-754-8986

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH S. HARGRAVE
Credential	:	O.D.
Telephone Number	:	716-754-8816

Provider Enumeration Date	:	05/21/2006
Last Update Date	:	05/05/2010

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