MEDICARE: DENNIS JOSEPH NEEDHAM OD

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	TUV004546-1	NY

General Provider Information

NPI Number	:	1801876420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS JOSEPH NEEDHAM OD

Provider Business Mailing Address
First Line	:	6 OLD MILL RUN
Second Line	:
City	:	DEPEW
State	:	NY
Zip	:	14043-5008
Country	:	US
Telephone Number	:	716-668-4177
Fax Number	:	716-668-4177

Provider Business Practice Location Address
First Line	:	5430 BROADWAY ST
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086-2124
Country	:	US
Telephone Number	:	716-685-4050
Fax Number	:	716-685-2873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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