MEDICARE: GINA LEE SAROW

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	156FX1100X	Ophthalmic Technician/Technologist	6922	NY

General Provider Information

NPI Number	:	1275855520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA LEE SAROW

Provider Business Mailing Address
First Line	:	55 MAIN ST
Second Line	:
City	:	AKRON
State	:	NY
Zip	:	14001-1239
Country	:	US
Telephone Number	:	716-542-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 MAIN ST
Second Line	:
City	:	AKRON
State	:	NY
Zip	:	14001-1239
Country	:	US
Telephone Number	:	716-542-2002
Fax Number	:

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

Provider Enumeration Date	:	02/26/2010
Last Update Date	:	02/26/2010

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