Provider Demographics
NPI:1811180755
Name:SPENCERPORT FAMILY EYECARE
Entity type:Organization
Organization Name:SPENCERPORT FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KILBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-586-6524
Mailing Address - Street 1:24 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1344
Mailing Address - Country:US
Mailing Address - Phone:585-352-1960
Mailing Address - Fax:
Practice Address - Street 1:24 WEST AVE
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1344
Practice Address - Country:US
Practice Address - Phone:585-352-1960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4644610001Medicare NSC
NYU19606Medicare UPIN
NYCC5374Medicare PIN
NYAA0828Medicare PIN