Kevin B Wynne OD PLLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

TUV005374-1 Issued in NY

Legal business name

KEVIN B WYNNE OD PLLC

Practice address

56 State St
Pittsford, NY 14534-2344

Phone

(585) 381-4640

NPI assigned

Feb 23, 2008

Last updated

Oct 17, 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 Bradley Wynne, O.D.NPI 1598752784

Title

Optometrist

Phone

(585) 381-4640

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Tax ID family

Kevin B Wynne OD PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Kevin B Wynne OD PLLC

  • Eyewear Supplier
  • Pittsford, NY
  • NPI 1114197431
  NPD tax ID
• Kevin B Wynne OD PLLC

  • Durable Medical Equipment & Medical Supplies
  • Pittsford, NY
  • NPI 1386818813
  NPD tax ID

Locations

Practitioners 1

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 Bradley Wynne, OD

  • Optometrist
  • Pittsford, NY
  • NPI 1598752784
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1203724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1922277938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 STATE ST",
            "city": "PITTSFORD",
            "state": "NY",
            "postal_code": "145342344",
            "telephone_number": "585-381-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 STATE ST",
            "city": "PITTSFORD",
            "state": "NY",
            "postal_code": "145342344",
            "telephone_number": "585-381-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN B WYNNE OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-23",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "WYNNE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "585-381-4640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NY",
            "license": "TUV005374-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "14929A",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS",
            "identifier": "P017155959",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Kenyon
• Howard Kessler, D.O.
• James David Kestenbaum, PH.D.
• Kevin B Wynne OD PLLC
• Kevin B Wynne OD PLLC
• Anteres Kil
• Alexandra Kiley, DPT
• Chung Hoon Kim, MD
• Jacqueline Kim, DDS
• Lauren Anne Kimble-Giglia

• Eyewear Supplier in Pittsford, NY
• Providers in Pittsford, NY by specialty
• Eyewear Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.