Provider Demographics
NPI:1144509381
Name:ERIE STATION OPTICAL, INC.
Entity type:Organization
Organization Name:ERIE STATION OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VELOCCI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-321-5581
Mailing Address - Street 1:20 FINN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9393
Mailing Address - Country:US
Mailing Address - Phone:585-321-5581
Mailing Address - Fax:585-321-0321
Practice Address - Street 1:20 FINN RD
Practice Address - Street 2:SUITE C
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9393
Practice Address - Country:US
Practice Address - Phone:585-321-5581
Practice Address - Fax:585-321-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0047231332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
T26144Medicare UPIN