Healthcare Provider Details

I. General information

NPI: 1366550410
Provider Name (Legal Business Name): HOWARD B KUSHNER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 MAPLE AVE
SARATOGA SPRINGS NY
12866
US

IV. Provider business mailing address

464 MAPLE AVE
SARATOGA SPRINGS NY
12866-5508
US

V. Phone/Fax

Practice location:
  • Phone: 518-886-1710
  • Fax: 518-886-1392
Mailing address:
  • Phone: 518-886-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number005227
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number005227
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number005227
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number005227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: