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Breanna Lynn Burgenstock
Optician in Watertown, New York
NPI 1982111803

Breanna Lynn Burgenstock is a Optician based in Watertown, NY and is specialized in Optician. Breanna Lynn Burgenstock practices in Watertown, NY. The NPI Number for Breanna Lynn Burgenstock is 1982111803 and holds a License No. 8463-1 (New York).

The current practice location address for Breanna Lynn Burgenstock is 20823 Nys Rt 3, Watertown, NY and can be reached out via phone at 315-788-1570.

Location: 20823 Nys Rt 3, Watertown, NY, 13601-5577
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1982111803
Provider Name
Breanna Lynn Burgenstock
Credential
Provider Entity Type
Individual
Gender
Female
Address
20823 Nys Rt 3, Watertown, NY, 13601-5577
Phone Number
315-788-1570
Fax Number
Provider Enumeration Date
12/30/2017
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
207069530 05 NY
institution
Provider Business Practice Location Address Details
Address
20823 Nys Rt 3
City
Watertown
State
New York
Zip
13601-5577
Phone Number
315-788-1570
Fax Number
person
Provider Business Mailing Address Details
Address
20823 Nys Rt 3
City
Watertown
State
New York
Zip
13601-5577
Phone Number
315-788-1570
Fax Number
person
Provider's Taxonomy Details 1
Type
Eye and Vision Services Providers
Classification
Technician/Technologist
Speciality
Optician
Taxonomy
156FX1800X
License No.
8463-1 (New York)
Definition
Definition to come...
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