Provider Demographics
NPI:1285784546
Name:TOCK, DAVID LEE (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:TOCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6867 AMANDA LN
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9659
Mailing Address - Country:US
Mailing Address - Phone:716-433-3324
Mailing Address - Fax:716-633-9583
Practice Address - Street 1:4545 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6012
Practice Address - Country:US
Practice Address - Phone:716-634-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY5036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU30592Medicare UPIN