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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