Individual
MRS. MICHELLE MARIA KAVANAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPHTHALMIC DISPENSER
Contact information
Practice address
3505 WATSON BLVD, ENDWELL, NY 13760
(607) 321-8333
Mailing address
3505 WATSON BLVD, ENDWELL, NY 13760
(607) 321-8333
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
009727
NY
Other
Enumeration date
04/05/2018
Last updated
04/05/2018
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