Provider Demographics
NPI:1083638126
Name:KANOFSKY, BARRY RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:RAYMOND
Last Name:KANOFSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 EAST STATE STREET
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-444-5522
Mailing Address - Fax:610-444-1568
Practice Address - Street 1:217 E STATE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3123
Practice Address - Country:US
Practice Address - Phone:610-444-5522
Practice Address - Fax:610-444-1568
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12941OtherSPECTERA
PA000092639OtherBLUE CROSS PERSONAL CHOIC
PA52883OtherDAVIS VISION
PA0017858OtherAETNA
PAPA04683OtherVISION BENEFITS OF AMERIC
DE231896238OtherBLUE CROSS OF DE
PAPA4683OtherEYEMED
PA232152757OtherVISION SERVICE PLAN
DE231896238OtherBLUE CROSS OF DE
PAKA92639Medicare ID - Type Unspecified
MA0135670001Medicare NSC