Healthcare Provider Details

I. General information

NPI: 1912689290
Provider Name (Legal Business Name): HANNAH R KINSELLA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PRESIDENTIAL PLZ
SYRACUSE NY
13202-2292
US

IV. Provider business mailing address

60 PRESIDENTIAL PLZ
SYRACUSE NY
13202-2292
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-4594
  • Fax:
Mailing address:
  • Phone: 315-472-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011390
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004064
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: