Healthcare Provider Details

I. General information

NPI: 1679673958
Provider Name (Legal Business Name): VICTORIA LEIGH DZURINKO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 CLEMENTS BRIDGE RD
DEPTFORD NJ
08096-2010
US

IV. Provider business mailing address

PO BOX 5401
DEPTFORD NJ
08096-0401
US

V. Phone/Fax

Practice location:
  • Phone: 856-537-7214
  • Fax: 856-579-4354
Mailing address:
  • Phone: 412-994-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOM00132800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNH0786
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4666
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOE000344G
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI3-0001407
License Number StateDE
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA000658900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: