Provider Demographics
NPI:1386717932
Name:GENTILE, ANN MARIE (OD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:PORTANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:179 RANDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1339
Mailing Address - Country:US
Mailing Address - Phone:716-688-9474
Mailing Address - Fax:716-684-1927
Practice Address - Street 1:2000 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-5454
Practice Address - Country:US
Practice Address - Phone:716-684-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY5816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU57547Medicare UPIN
NYCC8838Medicare ID - Type Unspecified