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General NPI Number Information
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NPI Number | 1275658924
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Entity Type | Organization
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Legal Business Name | KEVIN B. WYNNE, O.D.
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1524 CULVER RD
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City | ROCHESTER
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State | NY
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Zip | 14609-4241
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Country | US
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Telephone | 585-654-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 1524 CULVER RD
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City | ROCHESTER
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State | NY
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Zip | 14609-4241
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Country | US
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Telephone | 585-654-9200
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KEVIN BRADLEY WYNNE
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Credential | O.D.
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Telephone | 585-654-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | V005374
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License Number State | NY
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