MEDICARE: DR. OMAR ELIAS HANUCH MD

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	207W00000X	Ophthalmology Physician	1989451	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316929334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR ELIAS HANUCH MD

Provider Business Mailing Address
First Line	:	2300 BUFFALO RD
Second Line	:	BLDG 700
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1360
Country	:	US
Telephone Number	:	585-328-0153
Fax Number	:	585-328-0158

Provider Business Practice Location Address
First Line	:	2300 BUFFALO RD
Second Line	:	BLDG 700
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1360
Country	:	US
Telephone Number	:	585-328-0153
Fax Number	:	585-328-0158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	10/20/2022

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