Provider Demographics
NPI:1386750974
Name:COUNCIL OPTICIANS OF BATAVIA INC.
Entity type:Organization
Organization Name:COUNCIL OPTICIANS OF BATAVIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOUINLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-343-0633
Mailing Address - Street 1:216 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2221
Mailing Address - Country:US
Mailing Address - Phone:585-343-0633
Mailing Address - Fax:585-343-0211
Practice Address - Street 1:216 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2221
Practice Address - Country:US
Practice Address - Phone:585-343-0633
Practice Address - Fax:585-343-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYT005845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0474810001Medicare NSC
NYU74916Medicare UPIN