Provider Demographics
NPI:1811125180
Name:AMABILE, KRISTIN ALYSE (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ALYSE
Last Name:AMABILE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 FOX TRCE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-3072
Mailing Address - Country:US
Mailing Address - Phone:716-435-4010
Mailing Address - Fax:716-393-3839
Practice Address - Street 1:2064 SENECA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2343
Practice Address - Country:US
Practice Address - Phone:716-822-1515
Practice Address - Fax:716-393-3839
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03122534Medicaid
J300043848Medicare UPIN