Provider Demographics
NPI:1194791780
Name:PARK SHER OPTICAL CO OF BUFFALO NY INC
Entity type:Organization
Organization Name:PARK SHER OPTICAL CO OF BUFFALO NY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-713-2358
Mailing Address - Street 1:7 DIANE CT
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4933
Mailing Address - Country:US
Mailing Address - Phone:716-713-2358
Mailing Address - Fax:716-219-1176
Practice Address - Street 1:950 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2568
Practice Address - Country:US
Practice Address - Phone:585-671-6630
Practice Address - Fax:585-225-3293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK SHER OPTICAL CO OF BUFFALO NY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-24
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152W00000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP017085959OtherEXCELLUS HEALTH PLAN
NY2546649OtherAETNA
NY103137CTOtherPREFERRED CARE
NY2546649OtherAETNA