Provider Demographics
NPI:1487634150
Name:KAZDAN, CARY ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:ALAN
Last Name:KAZDAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 N WINTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1236
Mailing Address - Country:US
Mailing Address - Phone:585-586-6524
Mailing Address - Fax:585-586-9719
Practice Address - Street 1:1671 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2568
Practice Address - Country:US
Practice Address - Phone:585-586-6524
Practice Address - Fax:585-586-9719
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUT005157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC5374Medicare PIN
4644610001Medicare NSC