Basic Information
| Provider Information | |||||||||
| NPI: | 1285157966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVE | ||||||||
| FirstName: | AVANI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD, FAAO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 STERLING DR | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166776500 | ||||||||
| FaxNumber: | 7166776507 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 COMMONWEALTH AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022151274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172622020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | 5237 | MA | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152W00000X | 5237 | MA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.