Healthcare Provider Details

I. General information

NPI: 1790348720
Provider Name (Legal Business Name): DZURINKO EYE CARE SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2019
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: 856-579-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTORIA L DZURINKO
Title or Position: OWNER
Credential: OD
Phone: 412-994-0506