Provider Demographics
NPI:1538583356
Name:OCULOFACIAL PLASTIC SURGERY OF WNY PLLC
Entity type:Organization
Organization Name:OCULOFACIAL PLASTIC SURGERY OF WNY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:EMMETT
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-512-1617
Mailing Address - Street 1:5800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8220
Mailing Address - Country:US
Mailing Address - Phone:315-256-8826
Mailing Address - Fax:
Practice Address - Street 1:5800 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8220
Practice Address - Country:US
Practice Address - Phone:315-256-8826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242642207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty