Healthcare Provider Details

I. General information

NPI: 1124097878
Provider Name (Legal Business Name): ARTHUR W MRUCZEK SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ERIE STREET SOUTH LAKE PLAINS EYE CENTER
MEDINA NY
14103
US

IV. Provider business mailing address

500 ERIE STREET SOUTH LPEC MEDICAL EYE CARE PLLC
MEDINA NY
14103
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-2020
  • Fax: 585-798-3365
Mailing address:
  • Phone: 585-798-2020
  • Fax: 585-798-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number120403
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: