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Organization
THE OPTICAL ROOM INC
Active
Organization
THE OPTICAL ROOM INC
Active
Other names
the towpath optician
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH DOUGLAS CERVELLO (OWNER OPTICIAN)
(585) 637-5858
Entity
Organization
Contact information
Practice address
20 WEST AVE, BROCKPORT, NY 14420-1304
(585) 637-5858
Mailing address
20 WEST AVE, P.O. BOX 374, BROCKPORT, NY 14420-1304
(585) 637-5858
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
003478
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01712234
—
NM
01
—
8779
BLUE SHIELD VISION
NM
Enumeration date
10/26/2006
Last updated
03/11/2008
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