Healthcare Provider Details

I. General information

NPI: 1669433579
Provider Name (Legal Business Name): KATHLEEN MARGARET OSHEA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9233 S LAKE RD
CORFU NY
14036-9581
US

IV. Provider business mailing address

9233 S LAKE RD
CORFU NY
14036-9581
US

V. Phone/Fax

Practice location:
  • Phone: 716-597-4103
  • Fax: 888-203-2402
Mailing address:
  • Phone: 585-599-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: