Provider Demographics
NPI:1124265376
Name:BUFFALO NIAGARA RETINA ASSOCIATES, PC
Entity type:Organization
Organization Name:BUFFALO NIAGARA RETINA ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:THEURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-631-3300
Mailing Address - Street 1:6480 MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5852
Mailing Address - Country:US
Mailing Address - Phone:716-631-3300
Mailing Address - Fax:716-631-3303
Practice Address - Street 1:6480 MAIN ST
Practice Address - Street 2:SIUTE #1
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5852
Practice Address - Country:US
Practice Address - Phone:716-631-3300
Practice Address - Fax:716-631-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2358341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02676391Medicaid
H85004Medicare UPIN
NYJ100000145Medicare PIN