Organization
MAIN STREET OPTICAL
Active
Organization
MAIN STREET OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY T KISSACK O.D. (OWNER)
(585) 624-2122
Entity
Organization
Contact information
Practice address
1 N MAIN ST, 549, HONEOYE FALLS, NY 14472-1013
(585) 624-2122
(585) 624-2122
Mailing address
1 N MAIN ST, 549, HONEOYE FALLS, NY 14472-1013
(585) 624-2122
(585) 624-2122
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
004875
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100162
PREFERRED CARE
NY
05
—
31783B
—
NY
01
—
8788
EXCELLUS BC/BS
NY
Enumeration date
05/09/2008
Last updated
05/09/2008
Update your record
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