Individual
CHARLES FREDERICK TIEXEIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
2864 DELAWARE AVE, KENMORE, NY 14217-2731
(716) 874-4119
Mailing address
2864 DELAWARE AVE, KENMORE, NY 14217-2731
(716) 874-4119
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
C005693-1
NY
Other
Enumeration date
04/01/2008
Last updated
04/01/2008
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