National Provider Identifier
Kevin Bradley Wynne, OD
Kevin Bradley Wynne, OD is listed in the NPPES registry with a primary specialty of Optometrist in Pittsford, NY and a listed phone number of (585) 381-4640.
Profile Overview
- NPI
- 1598752784
- Provider Type
- Individual
- Primary Specialty
- Optometrist
- Enumeration Date
- October 03, 2005
- Last Updated
- October 17, 2022
Practice Location
- 56 State St
- Pittsford, NY 14534-2344
Phone: (585) 381-4640
Specialties
- Optometrist (152W00000X)
Full Record
- NPI
- 1598752784
- Entity Type
- Individual
- Last Name
- Wynne
- First Name
- Kevin
- Middle Name
- Bradley
- Credential
- OD
- Mailing Street Address
- 56 State St
- Mailing City
- Pittsford
- Mailing State
- NY
- Mailing ZIP Code
- 14534-2344
- Mailing Country
- US
- Mailing Phone
- (585) 381-4640
- Mailing Fax
- (585) 381-3322
- Practice Street Address
- 56 State St
- Practice City
- Pittsford
- Practice State
- NY
- Practice ZIP Code
- 14534-2344
- Practice Country
- US
- Practice Phone
- (585) 381-4640
- Practice Fax
- (585) 381-3322
- Enumeration Date
- October 03, 2005
- Last Updated
- October 17, 2022
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- October 17, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Optometrist (152W00000X)
- Other Identifiers
- 102002CS (NY, Preferred Care), 14929A (Medicare Group #), PO10005374 (NY, Blue Choice), 7100219 (NY, Aetna)