MEDICARE: GREGORY LORKOWSKI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5256TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083611164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY LORKOWSKI O.D.

Provider Business Mailing Address
First Line	:	2210 RED HAWK LN
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76039-6091
Country	:	US
Telephone Number	:	817-534-3200
Fax Number	:	817-536-4835

Provider Business Practice Location Address
First Line	:	8115 PRESTON RD
Second Line	:	STE 630
City	:	DALLAS
State	:	TX
Zip	:	75225-6342
Country	:	US
Telephone Number	:	214-360-9951
Fax Number	:	214-360-9819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/21/2011

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