Healthcare Provider Details

I. General information

NPI: 1366537532
Provider Name (Legal Business Name): JOHN BIELINSKI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3861 SOUTH PARK AVE.
BLASDELL NY
14219
US

IV. Provider business mailing address

138 SHARON DRIVE
W. SENECA NY
14224
US

V. Phone/Fax

Practice location:
  • Phone: 716-823-6093
  • Fax: 716-362-0913
Mailing address:
  • Phone: 716-675-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number003165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: