MEDICARE: CASIMIR K BOBOWSKI OD

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	332H00000X	Eyewear Supplier	TUV0042591	NY

General Provider Information

NPI Number	:	1720240559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASIMIR K BOBOWSKI OD

Provider Business Mailing Address
First Line	:	1342 NEW SENECA TPKE
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-8802
Country	:	US
Telephone Number	:	315-685-6185
Fax Number	:	315-685-2235

Provider Business Practice Location Address
First Line	:	1342 NEW SENECA TPKE
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-8802
Country	:	US
Telephone Number	:	315-685-6185
Fax Number	:	315-685-2235

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. CASIMIR K BOBOWSKI
Credential	:	O.D.
Telephone Number	:	315-685-6185

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/02/2008

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