Healthcare Provider Details

I. General information

NPI: 1548210131
Provider Name (Legal Business Name): GREGORY J FLAITZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 R C HOAG DR
SALAMANCA NY
14779-1365
US

IV. Provider business mailing address

7899 STATE ROUTE 21
HORNELL NY
14843-9669
US

V. Phone/Fax

Practice location:
  • Phone: 716-945-5894
  • Fax: 716-242-6345
Mailing address:
  • Phone: 605-200-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number558
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number235
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberRT006640
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: