Provider Demographics
NPI:1720493471
Name:MCGRAW, ALLISON MARIE (OD)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:MARIE
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:191 CLEVELAND AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222
Mailing Address - Country:US
Mailing Address - Phone:315-416-0521
Mailing Address - Fax:
Practice Address - Street 1:1176 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209
Practice Address - Country:US
Practice Address - Phone:716-881-7900
Practice Address - Fax:716-881-4349
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2423152W00000X
NYTUV008250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04176830Medicaid