Organization
KEVIN B. WYNNE, O.D.
Active
Organization
KEVIN B. WYNNE, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN BRADLEY WYNNE O.D. (OPTOMETRIST)
(585) 654-9200
Entity
Organization
Contact information
Practice address
1524 CULVER RD, ROCHESTER, NY 14609-4241
(585) 654-9200
Mailing address
1524 CULVER RD, ROCHESTER, NY 14609-4241
(585) 654-9200
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
V005374
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G0187194590
BLUE CHOICE GROUP NUMBER
NY
Enumeration date
03/20/2007
Last updated
08/22/2020
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