Provider Demographics
NPI:1962577569
Name:LICATA OPTICAL CO INC
Entity type:Organization
Organization Name:LICATA OPTICAL CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:LICATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-631-3860
Mailing Address - Street 1:8070 TRANSIT ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-631-3860
Mailing Address - Fax:716-631-3090
Practice Address - Street 1:8070 TRANSIT ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-631-3860
Practice Address - Fax:716-631-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7310246OtherIND HEALTH
NY000300065001OtherBLUE CROSS BLUE SHIELD
NY333541OtherNATIONAL VISION ADM
NY00026918201OtherUNIVERA
NY46028OtherSPECTERA
NY008564OtherBLOCK VISION
NY294082OtherHIMARK CLARITY
NYOP022902OtherEYEMED
NYOP2234OtherEYEMED
NY46028OtherSPECTERA