Provider Demographics
NPI:1730250226
Name:MAIN PLACE OPTICAL INC.
Entity type:Organization
Organization Name:MAIN PLACE OPTICAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-852-7572
Mailing Address - Street 1:390 -350 MAIN ST
Mailing Address - Street 2:MAIN PLACE MALL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-3750
Mailing Address - Country:US
Mailing Address - Phone:716-852-7572
Mailing Address - Fax:716-854-0954
Practice Address - Street 1:390 MAIN ST # 350
Practice Address - Street 2:MAIN PLACE MALL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3702
Practice Address - Country:US
Practice Address - Phone:716-852-7572
Practice Address - Fax:716-854-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005065332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011208601OtherUNIVERA
NY01561797Medicaid
NY000300100005OtherBCBS
NYNY5065OtherCOLE
NY08697OtherSPECTERA
NYNY5065OtherEYE MED
NY30174OtherDAVIS/FIDELIS
NYNY2984OtherEYE MED
NYNY2984OtherEYE MED