MEDICARE: DR. SANDRA L SEGERSON OD

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	TUV007634-1	NY

General Provider Information

NPI Number	:	1609182104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA L SEGERSON OD

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	:	716-876-3261

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	:	716-876-3261

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

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	08/23/2010

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