Provider Demographics
NPI:1245341015
Name:BRUNENAVS, DANIEL (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:BRUNENAVS
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 1:55 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2225
Mailing Address - Country:US
Mailing Address - Phone:716-366-4383
Mailing Address - Fax:716-366-8715
Practice Address - Street 1:55 E 4TH ST
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2225
Practice Address - Country:US
Practice Address - Phone:716-366-4383
Practice Address - Fax:716-366-8715
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5875270001Medicare NSC
NYCC2165Medicare PIN
NYU81962Medicare UPIN