Provider Demographics
NPI:1144366147
Name:SIDNEY HILLMAN HEALTH CNTR OF ROCHESTER
Entity type:Organization
Organization Name:SIDNEY HILLMAN HEALTH CNTR OF ROCHESTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SIDEBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-271-1911
Mailing Address - Street 1:750 EAST AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2100
Mailing Address - Country:US
Mailing Address - Phone:585-271-1911
Mailing Address - Fax:585-442-7216
Practice Address - Street 1:750 EAST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2100
Practice Address - Country:US
Practice Address - Phone:585-271-1911
Practice Address - Fax:585-442-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003607-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0845810002Medicare ID - Type UnspecifiedID NUMBER
NYA08009442Medicare ID - Type UnspecifiedSUBMITTER NUMBER