Provider Demographics
NPI:1730357112
Name:HAMBURG OPTICAL
Entity type:Organization
Organization Name:HAMBURG OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-649-1035
Mailing Address - Street 1:51 BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5001
Mailing Address - Country:US
Mailing Address - Phone:716-649-1035
Mailing Address - Fax:716-649-1035
Practice Address - Street 1:51 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5001
Practice Address - Country:US
Practice Address - Phone:716-649-1035
Practice Address - Fax:716-649-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY5219332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY089367359Medicare UPIN
0183660001Medicare NSC