Basic Information
Provider Information
NPI: 1003018102
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COTTER
FirstName: DANIEL
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3712 SOUTHWESTERN BLVD
Address2:  
City: ORCHARD PARK
State: NY
PostalCode: 141271720
CountryCode: US
TelephoneNumber: 7164322253
FaxNumber:  
Practice Location
Address1: 811 MAPLE RD
Address2:  
City: WILLIAMSVILLE
State: NY
PostalCode: 142213260
CountryCode: US
TelephoneNumber: 7166318888
FaxNumber: 7166483185
Other Information
ProviderEnumerationDate: 06/01/2007
LastUpdateDate: 04/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X233935NYY Allopathic & Osteopathic PhysiciansOphthalmology 
207W00000XA100203CAN Allopathic & Osteopathic PhysiciansOphthalmology 

ID Information
IDTypeStateIssuerDescription
23393501NYNY LICENSEOTHER


Home