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Individual

BREANNA LYNN BURGENSTOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
20823 NYS RT 3, WATERTOWN, NY 13601-5577
(315) 788-1570
Mailing address
20823 NYS RT 3, WATERTOWN, NY 13601-5577

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
8463-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
207069530
NY
Enumeration date
12/30/2017
Last updated
06/16/2018
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