Provider Demographics
NPI:1093062499
Name:KALINOWSKI, LAUREN A (OD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:KALINOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6737
Mailing Address - Country:US
Mailing Address - Phone:716-833-2020
Mailing Address - Fax:716-833-3854
Practice Address - Street 1:5500 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6737
Practice Address - Country:US
Practice Address - Phone:716-833-2020
Practice Address - Fax:716-833-3854
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04371371Medicaid