Provider Demographics
NPI:1235352980
Name:SPENCERPORT FAMILY EYE CARE
Entity Type:Organization
Organization Name:SPENCERPORT FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAZDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-352-1960
Mailing Address - Street 1:24 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559
Mailing Address - Country:US
Mailing Address - Phone:585-352-1960
Mailing Address - Fax:585-349-7076
Practice Address - Street 1:24 WEST AVE
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559
Practice Address - Country:US
Practice Address - Phone:585-352-1960
Practice Address - Fax:585-349-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005157152W00000X, 332B00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD4197OtherPREFERRED ONE
U19606Medicare UPIN
CC5374Medicare ID - Type Unspecified