Provider Demographics
NPI:1144358052
Name:ANNE, DOUGLAS G
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:G
Last Name:ANNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 DEPEW RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9702
Mailing Address - Country:US
Mailing Address - Phone:585-526-5450
Mailing Address - Fax:
Practice Address - Street 1:3635 DEPEW RD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9702
Practice Address - Country:US
Practice Address - Phone:585-526-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3057156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician