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NPI Code Detail

MEDICARE: ELIZABETH PIERCE OLMSTED, MD CENTER FOR THE VISUALLY IMPAIRED

MEDICARE: ELIZABETH PIERCE OLMSTED, MD CENTER FOR THE VISUALLY IMPAIRED
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
1152W00000XOptometrist005472NY

General Provider Information

NPI Number : 1588747109
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELIZABETH PIERCE OLMSTED, MD CENTER FOR THE VISUALLY IMPAIRED
Provider Business Mailing Address
First Line : 908 NIAGARA FALLS BLVD
Second Line : SUITE 208
City : NORTH TONAWANDA
State : NY
Zip : 14120-2019
Country : US
Telephone Number : 716-692-3302
Fax Number : 716-692-4342
Provider Business Practice Location Address
First Line : 1170 MAIN ST
Second Line :
City : BUFFALO
State : NY
Zip : 14209-2331
Country : US
Telephone Number : 716-882-1025
Fax Number : 716-882-5577
Authorized Official
Title or Position : DOCTOR OF OPTOMETRY
Name : JAMES SIMMONS
Credential : OD
Telephone Number : 716-882-1025
Provider Enumeration Date : 10/24/2006
Last Update Date : 08/22/2020

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