Provider Demographics
NPI:1114724465
Name:AZURE AESTHETICS AND OCULOFACIAL PLASTIC SURGERY PC
Entity type:Organization
Organization Name:AZURE AESTHETICS AND OCULOFACIAL PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-319-2284
Mailing Address - Street 1:4590 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4548
Mailing Address - Country:US
Mailing Address - Phone:585-319-2284
Mailing Address - Fax:
Practice Address - Street 1:4590 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4548
Practice Address - Country:US
Practice Address - Phone:585-319-2284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty