Provider Demographics
NPI:1104810845
Name:BIONDOLILLO, JOSEPH C (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:BIONDOLILLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4471
Mailing Address - Country:US
Mailing Address - Phone:716-649-1010
Mailing Address - Fax:716-649-1382
Practice Address - Street 1:206 LAKE ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4471
Practice Address - Country:US
Practice Address - Phone:716-649-1010
Practice Address - Fax:716-649-1382
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0038391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15568OtherSPECTERA
NY161150836OtherTRICARE
NY612OtherDAVIS VISION
NYNY3839OtherEYEMED
NY330823OtherNATIONAL VISION ADMINISTR
NY7166491010OtherVISION SERVICE PLAN
NMNY3839OtherVISION BENEFITS OF AMERIC
NY000300107001OtherBLUE CROSS BLUE SHIELD
NY161150836OtherEMPIRE
NY7209491OtherINDEPENDENT HEALTH
NY00020345201OtherUNIVERA
NY000300107001OtherBLUE CROSS BLUE SHIELD
NY081141Medicare PIN
NY7209491OtherINDEPENDENT HEALTH
NYJ400035960Medicare PIN
NYNY3839OtherEYEMED