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General NPI Number Information
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NPI Number | 1437328945
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Entity Type | Organization
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Legal Business Name | J. KENT MAURER, OD
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 749 PRE EMPTION RD
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City | GENEVA
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State | NY
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Zip | 14456-1335
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Country | US
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Telephone | 315-789-8122
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Fax | 315-789-0557
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Provider Business Mailing Address
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Address Line | 749 PRE EMPTION RD P.O. BOX 231
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City | GENEVA
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State | NY
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Zip | 14456-1335
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Country | US
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Telephone | 315-789-8122
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Fax | 315-789-0557
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JOHN KENT MAURER
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Credential | OD
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Telephone | 31577898122
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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 | TUV003768-1
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License Number State | NY
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