Organization
O.D. OPTOMETRIC P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MICHAEL SAN GEORGE II O.D. (PRESIDENT)
(716) 646-0564
Entity
Organization
Contact information
Practice address
4255 MCKINLEY PKWY, HAMBURG, NY 14075-1005
(716) 646-0564
(716) 646-0571
Mailing address
4255 MCKINLEY PKWY, INSIDE WAL-MART VISION CENTER, HAMBURG, NY 14075-1005
(716) 646-0564
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV006278
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00027038101
UNIVERA
NY
01
—
000390184006
BLUECROSS BLUESHIELD
NY
01
—
13693
AVESIS
NY
01
—
17205
SPECTERA
NY
01
—
48568
DAVIS VISION
NY
01
—
552405
NVA
NY
01
—
919920
BLOCK VISION
NY
01
—
988665
CLARITY VISION
NY
01
—
NY6278
COLE MANAGED VISION
NY
Enumeration date
10/18/2006
Last updated
06/21/2018
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