Healthcare Provider Details

I. General information

NPI: 1619060951
Provider Name (Legal Business Name): ZENON CIOPYK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E UNION ST
NEWARK NY
14513-1503
US

IV. Provider business mailing address

3336 LAKES CORNERS ROSE VALLEY RD
CLYDE NY
14433-9724
US

V. Phone/Fax

Practice location:
  • Phone: 315-331-7917
  • Fax: 315-331-7917
Mailing address:
  • Phone: 315-587-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: