Healthcare Provider Details

I. General information

NPI: 1972726321
Provider Name (Legal Business Name): CARY A KAZDAN OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 PENFIELD RD
ROCHESTER NY
14625-2568
US

IV. Provider business mailing address

1671 PENFIELD RD
ROCHESTER NY
14625-2568
US

V. Phone/Fax

Practice location:
  • Phone: 583-586-6524
  • Fax: 585-586-9719
Mailing address:
  • Phone: 583-586-6524
  • Fax: 585-586-9719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT005157
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberVUT005157
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberVUT005157
License Number StateNY

VIII. Authorized Official

Name: DR. CARY A KAZDAN
Title or Position: OWNER
Credential: OD
Phone: 585-586-6524