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NPI Code Detail

MEDICARE: MAIN PLACE OPTICAL INC.

MEDICARE: MAIN PLACE OPTICAL 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
1332H00000XEyewear SupplierVUT005065NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100011208601OTHERNYUNIVERA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000300100005OTHERNYBCBS
4NY5065OTHERNYCOLE
508697OTHERNYSPECTERA
6NY5065OTHERNYEYE MED
730174OTHERNYDAVIS/FIDELIS
8NY2984OTHERNYEYE MED

General Provider Information

NPI Number : 1730250226
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAIN PLACE OPTICAL INC.
Provider Business Mailing Address
First Line : 390 -350 MAIN ST
Second Line : MAIN PLACE MALL
City : BUFFALO
State : NY
Zip : 14202-3750
Country : US
Telephone Number : 716-852-7572
Fax Number : 716-854-0954
Provider Business Practice Location Address
First Line : 390 MAIN ST # 350
Second Line : MAIN PLACE MALL
City : BUFFALO
State : NY
Zip : 14202-3702
Country : US
Telephone Number : 716-852-7572
Fax Number : 716-854-0954
Authorized Official
Title or Position : PRESIDENT
Name : MR. DENNIS OSIAK
Credential :
Telephone Number : 716-852-7572
Provider Enumeration Date : 11/13/2006
Last Update Date : 04/20/2008

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Directions to “MAIN PLACE OPTICAL INC. ” Practice Location

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