Provider Demographics
NPI:1124754213
Name:EYES EXCLUSIVE
Entity type:Organization
Organization Name:EYES EXCLUSIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HORNBERGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:716-863-4030
Mailing Address - Street 1:600 MAIN ST UNIT 1203
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1919
Mailing Address - Country:US
Mailing Address - Phone:716-863-4030
Mailing Address - Fax:716-551-0743
Practice Address - Street 1:846 MAIN ST STE R4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1442
Practice Address - Country:US
Practice Address - Phone:716-300-8482
Practice Address - Fax:716-551-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty