Provider Demographics
NPI:1124248760
Name:ENDRES, CARL RICHARD (OPTHALMIC DISPENSER)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:RICHARD
Last Name:ENDRES
Suffix:
Gender:M
Credentials:OPTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5470 ABEL RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3641
Mailing Address - Country:US
Mailing Address - Phone:716-648-7575
Mailing Address - Fax:
Practice Address - Street 1:1777 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4624
Practice Address - Country:US
Practice Address - Phone:716-674-8446
Practice Address - Fax:716-674-2682
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003507156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician