Lake Shore Audiology, P C

Primary specialty

Audiologist-Hearing Aid FitterTaxonomy code 237600000X

License

15000008841 Issued in NY

Legal business name

LAKE SHORE AUDIOLOGY, P C

Practice address

3085 Southwestern Blvd Ste 103
Orchard Park, NY 14127-1234

Phone

(716) 674-4188

Fax

(716) 674-4834

NPI assigned

Dec 27, 2006

Last updated

Dec 1, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin G Flanagan, AUDNPI 1437190451

Title

Audiologist Owner

Phone

(716) 934-2025

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin G Flanagan, AV D

  • Audiologist-Hearing Aid Fitter
  • Irving, NY
  • NPI 1437190451
  Medicare reassignment NPD Authorized official
• Tara Bodziak, AU.D

  • Audiologist
  • Orchard Park, NY
  • NPI 1073036927
  Medicare reassignment NPD
• Dianna Lynn Theokas, AU.D.

  • Audiologist
  • Las Vegas, NV
  • NPI 1376659185
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1811052939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "849 RT 5 & 20",
            "city": "IRVING",
            "state": "NY",
            "postal_code": "14081",
            "telephone_number": "716-934-2025",
            "fax_number": "716-674-1836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3085 SOUTHWESTERN BLVD STE 103",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271234",
            "telephone_number": "716-674-4188",
            "fax_number": "716-674-4834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "849 Rt 5 & 20",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "NY",
            "postal_code": "14081",
            "country_code": "US",
            "telephone_number": "716-934-2025",
            "fax_number": "716-674-1836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE SHORE AUDIOLOGY, P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A",
        "authorized_official_last_name": "FLANAGAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "AUDIOLOGIST OWNER",
        "authorized_official_telephone_number": "716-934-2025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "AUD"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "NY",
            "license": "001421-2",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "NY",
            "license": "15000008841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00011388701",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "9210249",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "contact@lakeshoreaudiology.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3085 Southwestern Blvd Ste 103",
            "city": "Orchard Park",
            "state": "NY",
            "country_code": "US",
            "postal_code": "141271234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lauren Marie Kuwik, MD
• William Kwiek III
• William Kwik, O.D.
• Caitlin Lachaal
• Erin Lafferty
• Candace Lambert, SLP
• Kimberly June Lamoreaux
• Susan Elizabeth Lang, SLP
• Denita Langhorne
• Melenie Lanier

• Audiologist-Hearing Aid Fitter in Orchard Park, NY
• Providers in Orchard Park, NY by specialty
• Audiologist-Hearing Aid Fitter in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.