Basic Information
| Provider Information | |||||||||
| NPI: | 1871157503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN NEW YORK MEDICAL PRACTICE P.C | ||||||||
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| OtherOrganizationName: | WNY REED EYE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KINGS HWY S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146175504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859221900 | ||||||||
| FaxNumber: | 5859220636 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 KREAG RD | ||||||||
| Address2: | |||||||||
| City: | PITTSFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145343705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852498300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2019 | ||||||||
| LastUpdateDate: | 05/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | MAYO | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER/EVP RRH ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 5859220467 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WESTERN NEW YORK MEDICAL PRACTICE P.C | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.