Healthcare Provider Details

I. General information

NPI: 1942723291
Provider Name (Legal Business Name): KIMBERLY-ANNE LLAMZON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 MCKINLEY PKWY
BLASDELL NY
14219
US

IV. Provider business mailing address

3840 MCKINLEY PKWY
BLASDELL NY
14219-3006
US

V. Phone/Fax

Practice location:
  • Phone: 716-822-1000
  • Fax: 716-822-8873
Mailing address:
  • Phone: 716-822-1000
  • Fax: 716-822-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number008623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: