Individual
MS. MARY VERONICA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
3768 SENECA STREET, WEST SENECA, NY 14224
(716) 674-8300
(716) 674-8302
Mailing address
3768 SENECA STREET, WEST SENECA, NY 14224
(716) 674-8300
(716) 674-8302
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
0038461
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NY3846
EYEMED
NY
Enumeration date
11/06/2006
Last updated
07/08/2007
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