Provider Demographics
NPI:1154472389
Name:LAURY, ARTHUR O (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:O
Last Name:LAURY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2623
Mailing Address - Country:US
Mailing Address - Phone:716-664-4708
Mailing Address - Fax:716-483-1955
Practice Address - Street 1:707 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2623
Practice Address - Country:US
Practice Address - Phone:716-664-4708
Practice Address - Fax:716-483-1955
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC0034861156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50495OtherDAVIS VISION
NY00602704Medicaid
NY3486OtherEYE MED
NYNY0486OtherEYEMED
NY0576360001Medicare NSC