Individual provider Active NPI

Kenneth J Glasgow, OPTICIAN AAS

  • Optician
  • Buffalo, NY
National Provider Identifier
1891977377
Registry record updated Nov 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
C003597 Issued in NY
Practice address
41 North Street
Buffalo, NY 14202-1105
Phone
(716) 883-2020
Fax
(716) 883-2020
NPI assigned
Nov 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optician 156FX1800X C003597 NY Primary

Addresses

Primary practice location

41 North Street
Buffalo, NY 14202-1105

Mailing address

41 North Street
Buffalo, NY 14202-1105
Phone (716) 883-2020

Other identifiers 1

IdentifierTypeStateIssuer
00594803MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Associate of Applied Science

State licenses

LicenseStateTypeSpecialty
C003597NYMDOptician

NPI Registry JSON

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1891977377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 NORTH STREET",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142021105",
            "telephone_number": "716-883-2020",
            "fax_number": "716-883-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 NORTH STREET",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142021105",
            "telephone_number": "716-883-2020",
            "fax_number": "716-883-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASGOW",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "OPTICIAN AAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-27",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "C003597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00594803",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.