Vivian Kudgus Fasula, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

148889 Issued in NY

Practice address

70 Professional Parkway
Lockport, NY 14094-5366

Phone

(716) 434-7505

NPI assigned

Apr 28, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Charles J Fetterman MD PC

  • Ophthalmology Physician
  • Lockport, NY
  • NPI 1316004013
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242259200000",
    "number": "1073570396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1254 CHARLESGATE CIRCLE",
            "city": "EAST AMHERST",
            "state": "NY",
            "postal_code": "140511216",
            "telephone_number": "716-636-0113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 PROFESSIONAL PARKWAY",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140945366",
            "telephone_number": "716-434-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASULA",
        "first_name": "VIVIAN",
        "middle_name": "KUDGUS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-28",
        "last_updated": "2009-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "148889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00824488",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "D30278",
            "identifier": "DISABILITY",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL ID",
            "identifier": "16-1383123",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul M Errico, PMHNP
• Patricia Ann Farino, OCCUPATIONAL THERAPI
• Betsy Jean Farkas, LMSW
• Kevin P Farrell, DDS
• Farzana Habib
• Hany Antoun Fattouch, M.D.
• James Edmund Ferington, D.D.S.
• Sally Ferrigno, LMSW
• Charles J Fetterman, MD
• Meghann Elizabeth Fiegl, D.C.

• Ophthalmology Physician in Lockport, NY
• Providers in Lockport, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.