Provider Demographics
NPI:1013042423
Name:KENEFICK, LINDA LYNN (OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LYNN
Last Name:KENEFICK
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LEHIGH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14206-2512
Mailing Address - Country:US
Mailing Address - Phone:716-892-4914
Mailing Address - Fax:
Practice Address - Street 1:2735 S PARK AVE
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1531
Practice Address - Country:US
Practice Address - Phone:716-826-9230
Practice Address - Fax:716-896-0171
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005262-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005262-1OtherOPHTHALMIC LICENSE
NYNY5262OtherEYEMED