Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005262-1 | NY |
NPI | 1013042423 |
---|---|
Provider Name | Ms. Linda Lynn Kenefick |
First Address | Buffalo, NY 14206-2512 |
Second Address | Lackawanna, NY 14218-1531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005262-1 | OPHTHALMIC LICENSE (01) | NY |
NY5262 | EYEMED (01) | NY |