Provider Demographics
NPI:1962560045
Name:CZORA, ERIC PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:CZORA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120
Mailing Address - Country:US
Mailing Address - Phone:716-692-6961
Mailing Address - Fax:716-692-4010
Practice Address - Street 1:968 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120
Practice Address - Country:US
Practice Address - Phone:716-692-6961
Practice Address - Fax:716-692-4010
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01075929Medicaid
NY30169OtherDAVID VISION
NY00608OtherDAVIS VISION
NY01075929Medicaid
NY30169OtherDAVID VISION