MEDICARE: LINDA MARIE MCNAUGHTON OPTICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1326275892	OTHER	NY	NPI

General Provider Information

NPI Number	:	1487704110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA MARIE MCNAUGHTON OPTICIAN

Provider Business Mailing Address
First Line	:	2300 BUFFALO RD
Second Line	:	BLDG 700
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1367
Country	:	US
Telephone Number	:	585-328-0153
Fax Number	:	585-328-0158

Provider Business Practice Location Address
First Line	:	485 TITUS AVE
Second Line	:	SUITE A
City	:	ROCHESTER
State	:	NY
Zip	:	14617-3535
Country	:	US
Telephone Number	:	585-266-5636
Fax Number	:	585-266-5177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	03/22/2012

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