Provider Demographics
NPI:1962696443
Name:COUNCIL EYE CARE INC
Entity type:Organization
Organization Name:COUNCIL EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-633-2440
Mailing Address - Street 1:4243 TRANSIT RD
Mailing Address - Street 2:TRANSITOWN PLAZA
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7205
Mailing Address - Country:US
Mailing Address - Phone:716-633-2440
Mailing Address - Fax:716-633-6109
Practice Address - Street 1:4243 TRANSIT RD
Practice Address - Street 2:TRANSITOWN PLAZA
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7205
Practice Address - Country:US
Practice Address - Phone:716-633-2440
Practice Address - Fax:716-633-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00736645Medicaid
BA0506Medicare PIN
U93465Medicare UPIN
NY00736645Medicaid