MEDICARE: KENMORE EYECARE INC.

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	152W00000X	Optometrist	TUV004496	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497943096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENMORE EYECARE INC.

Provider Business Mailing Address
First Line	:	924 KENMORE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-1451
Country	:	US
Telephone Number	:	716-876-2020
Fax Number	:	716-876-2020

Provider Business Practice Location Address
First Line	:	924 KENMORE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-1451
Country	:	US
Telephone Number	:	716-876-2020
Fax Number	:	716-876-2020

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. DAVID ALAN BURSTEIN
Credential	:	OD
Telephone Number	:	716-876-2020

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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