Organization
KEVIN B WYNNE OD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN BRADLEY WYNNE O.D. (OPTOMETRIST)
(585) 381-4640
Entity
Organization
Contact information
Practice address
56 STATE ST, PITTSFORD, NY 14534-2344
(585) 381-4640
Mailing address
56 STATE ST, PITTSFORD, NY 14534-2344
(585) 381-4640
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
TUV005374-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14929A
MEDICARE GROUP
NY
01
—
P017155959
EXCELLUS
NY
Enumeration date
02/23/2008
Last updated
10/17/2022
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