Provider Demographics
NPI:1609182104
Name:SEGERSON, SANDRA L (OD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:SEGERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1451
Mailing Address - Country:US
Mailing Address - Phone:716-876-2020
Mailing Address - Fax:716-876-3261
Practice Address - Street 1:924 KENMORE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1451
Practice Address - Country:US
Practice Address - Phone:716-876-2020
Practice Address - Fax:716-876-3261
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007634-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist