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General NPI Number Information
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NPI Number | 1881783819
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Entity Type | Organization
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Legal Business Name | KENNETH G VANDINE MDPC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 12 MARTIN ST
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City | WELLSVILLE
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State | NY
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Zip | 14895-1057
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Country | US
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Telephone | 585-593-6041
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Fax |
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Provider Business Mailing Address
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Address Line | 12 MARTIN ST
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City | WELLSVILLE
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State | NY
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Zip | 14895-1057
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Country | US
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Telephone | 585-593-6041
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ERIC PAUL VOSSLER
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Credential |
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Telephone | 585-593-6041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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