Provider Demographics
NPI:1114197738
Name:DANIEL BRUNENAVS
Entity type:Organization
Organization Name:DANIEL BRUNENAVS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNENAVS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-366-4383
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5875270001Medicare NSC