Provider Demographics
NPI:1306890496
Name:JOSEPH S HARGRAVE OD PC
Entity type:Organization
Organization Name:JOSEPH S HARGRAVE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-754-8816
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-8146
Mailing Address - Country:US
Mailing Address - Phone:716-754-4405
Mailing Address - Fax:
Practice Address - Street 1:225 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1700
Practice Address - Country:US
Practice Address - Phone:716-754-8816
Practice Address - Fax:716-754-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty