MEDICARE: DR. JOSEPH HARGRAVE O.D.

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
2	152WC0802X	Corneal and Contact Management Optometrist	TUV004999	NY

General Provider Information

NPI Number	:	1417106832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH HARGRAVE O.D.

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

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

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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