Provider Demographics
NPI:1164546941
Name:FREDERICK J FOUQUET, OD PC & KEVIN B WYNNE, OD, PTRS
Entity Type:Organization
Organization Name:FREDERICK J FOUQUET, OD PC & KEVIN B WYNNE, OD, PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-381-4640
Mailing Address - Street 1:56 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2344
Mailing Address - Country:US
Mailing Address - Phone:585-381-4640
Mailing Address - Fax:585-381-3322
Practice Address - Street 1:56 STATE ST
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2344
Practice Address - Country:US
Practice Address - Phone:585-381-4640
Practice Address - Fax:585-381-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0817810001Medicare NSC