Provider Demographics
NPI:1669433579
Name:OSHEA, KATHLEEN MARGARET (OD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARGARET
Last Name:OSHEA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9233 S LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9581
Mailing Address - Country:US
Mailing Address - Phone:585-599-3966
Mailing Address - Fax:
Practice Address - Street 1:9233 S LAKE RD
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9581
Practice Address - Country:US
Practice Address - Phone:716-597-4103
Practice Address - Fax:888-203-2402
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01610104Medicaid
NY01610104Medicaid
U29715Medicare UPIN