Provider Demographics
NPI:1255516241
Name:RAYMOND, ANTHONY RONALD (OPTICIAN)
Entity type:Individual
Prefix:MISS
First Name:ANTHONY
Middle Name:RONALD
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-3032
Mailing Address - Country:US
Mailing Address - Phone:716-834-9500
Mailing Address - Fax:
Practice Address - Street 1:257 KENMORE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-3032
Practice Address - Country:US
Practice Address - Phone:716-834-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY3630156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician