MEDICARE: NIAGARA LABMASTERS, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1558549477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIAGARA LABMASTERS, INC.

Provider Business Mailing Address
First Line	:	1635 MILITARY RD
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-1745
Country	:	US
Telephone Number	:	716-297-9115
Fax Number	:	716-297-4270

Provider Business Practice Location Address
First Line	:	1635 MILITARY RD
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-1745
Country	:	US
Telephone Number	:	716-297-9115
Fax Number	:	716-297-4270

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MR. RICHARD B KOMM
Credential	:	OPTICIAN
Telephone Number	:	716-694-4388

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/01/2008

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