MEDICARE: EYE CARE PROFESSIONALS OF WESTERN NEW YORK, LLP

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

General Provider Information

NPI Number	:	1619194115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE PROFESSIONALS OF WESTERN NEW YORK, LLP

Provider Business Mailing Address
First Line	:	5500 MAIN ST
Second Line	:	SUITE 102
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-6755
Country	:	US
Telephone Number	:	716-833-2020
Fax Number	:	716-833-3854

Provider Business Practice Location Address
First Line	:	4703 TRANSIT RD
Second Line	:
City	:	DEPEW
State	:	NY
Zip	:	14043-4861
Country	:	US
Telephone Number	:	716-656-2011
Fax Number	:	716-656-1946

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	CATHERINE R HEINRICH
Credential	:
Telephone Number	:	716-833-2020

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	04/15/2015

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