Individual
DR. DONNA KIMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTOMETRIST
Contact information
Practice address
1161 ABBOTT RD, BUFFALO, NY 14220-2701
(716) 824-2631
Mailing address
8326 BACK CREEK RD, BOSTON, NY 14025-9702
(716) 941-9150
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
VUT004790-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000390033002
BCBS COMMUNITY BLUE
NY
01
—
VUT004790-1
LICENSE
NY
Enumeration date
01/18/2007
Last updated
07/08/2007
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