Provider Demographics
NPI:1437328945
Name:J. KENT MAURER, OD
Entity Type:Organization
Organization Name:J. KENT MAURER, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:3157-789-8122
Mailing Address - Street 1:749 PRE EMPTION RD
Mailing Address - Street 2:P.O. BOX 231
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1335
Mailing Address - Country:US
Mailing Address - Phone:315-789-8122
Mailing Address - Fax:315-789-0557
Practice Address - Street 1:749 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1335
Practice Address - Country:US
Practice Address - Phone:315-789-8122
Practice Address - Fax:315-789-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003768-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0594080001Medicare NSC