MEDICARE: PARK SHER OPTICAL CO OF BUFFALO NY 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	156FX1800X	Optician	07272	NY
2	152W00000X	Optometrist	007272	NY

General Provider Information

NPI Number	:	1659779338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK SHER OPTICAL CO OF BUFFALO NY INC

Provider Business Mailing Address
First Line	:	642 SHERIDAN DR
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-7853
Country	:	US
Telephone Number	:	716-695-3733
Fax Number	:	716-646-3926

Provider Business Practice Location Address
First Line	:	642 SHERIDAN DR
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-7853
Country	:	US
Telephone Number	:	716-695-3733
Fax Number	:	716-646-3926

Authorized Official
Title or Position	:	OD
Name	:	ROBERT JUDE JOBA
Credential	:
Telephone Number	:	716-947-2462

Provider Enumeration Date	:	12/12/2014
Last Update Date	:	09/17/2025

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