Organization
SOUTH PARK OPTICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES GORDON BEITER SR. (OPTICIAN)
(716) 823-6093
Entity
Organization
Contact information
Practice address
3861 S PARK AVE, BLASDELL, NY 14219-1813
(716) 823-6093
Mailing address
3861 S PARK AVE, BLASDELL, NY 14219-1813
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
C-5093-1
NY
332H00000X
Eyewear Supplier
Primary
5093
NY
Other
Enumeration date
10/11/2006
Last updated
12/05/2014
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