Provider Demographics
NPI:1124202635
Name:BARRY KANOFSKY OD PA
Entity Type:Organization
Organization Name:BARRY KANOFSKY OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KANOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-444-5522
Mailing Address - Street 1:217 E STATE ST
Mailing Address - Street 2:# 219
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3123
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:# 219
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72730Medicare UPIN
1124202635Medicare NSC