Provider Demographics
NPI:1689657702
Name:KANE, BRIAN JEFFERY (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEFFERY
Last Name:KANE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1615
Mailing Address - Country:US
Mailing Address - Phone:440-352-0616
Mailing Address - Fax:440-352-0618
Practice Address - Street 1:77 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1615
Practice Address - Country:US
Practice Address - Phone:440-352-0616
Practice Address - Fax:440-352-0618
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0459070Medicaid
OH410040652Medicare PIN
OHU64696Medicare UPIN
OH0811673Medicare PIN
OH0459070Medicaid
OH0811675Medicare PIN