Provider Demographics
NPI:1063736775
Name:O'NEIL'S VISION
Entity type:Organization
Organization Name:O'NEIL'S VISION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-381-1616
Mailing Address - Street 1:3349 MONROE AVE
Mailing Address - Street 2:PEARLE VISION
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3349 MONROE AVE
Practice Address - Street 2:PEARLE VISION
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5513
Practice Address - Country:US
Practice Address - Phone:585-381-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8005-1156FX1800X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty