Provider Demographics
NPI:1588752323
Name:KOMM, RICHARD BARRY (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BARRY
Last Name:KOMM
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:EUGENE
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:2342 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-4759
Mailing Address - Country:US
Mailing Address - Phone:716-694-4388
Mailing Address - Fax:716-694-1140
Practice Address - Street 1:2342 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-4759
Practice Address - Country:US
Practice Address - Phone:716-694-4388
Practice Address - Fax:716-694-1140
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3610156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0509630002Medicare ID - Type Unspecified