Provider Demographics
NPI:1962526814
Name:BROWNSTEN, SHERWIN W (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:SHERWIN
Middle Name:W
Last Name:BROWNSTEN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3708
Mailing Address - Country:US
Mailing Address - Phone:716-434-6900
Mailing Address - Fax:716-434-8461
Practice Address - Street 1:36 EAST AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3708
Practice Address - Country:US
Practice Address - Phone:716-434-6900
Practice Address - Fax:716-434-8461
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004097-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00640799Medicaid