Provider Demographics
NPI:1144284043
Name:VISIONARY OPHTHALMOLOGY AND CATARACT CARE, PLLC
Entity type:Organization
Organization Name:VISIONARY OPHTHALMOLOGY AND CATARACT CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:NISWANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-634-4441
Mailing Address - Street 1:40 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 N UNION RD
Practice Address - Street 2:NISWANDER EYE CENTER
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5339
Practice Address - Country:US
Practice Address - Phone:716-634-4441
Practice Address - Fax:716-634-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005781-1152W00000X
332H00000X
NY142714207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01632920Medicaid
NY390088001OtherBLUE CROSS GROUP NUMBER
NY390088001OtherBLUE CROSS GROUP NUMBER
NY0346410001Medicare NSC