Organization
LAKE SHORE AUDIOLOGY, P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN G FLANAGAN AUD (AUDIOLOGIST OWNER)
(716) 934-2025
Entity
Organization
Contact information
Practice address
3085 SOUTHWESTERN BLVD STE 103, ORCHARD PARK, NY 14127-1234
(716) 674-4188
(716) 674-4834
Mailing address
849 RT 5 & 20, IRVING, NY 14081
(716) 934-2025
(716) 674-1836
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
001421-2
NY
237600000X
Audiologist-Hearing Aid Fitter
Primary
15000008841
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011388701
UNIVERA
—
01
—
9210249
INDEPENDENT HEALTH
—
Enumeration date
12/27/2006
Last updated
12/01/2022
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