Healthcare Provider Details

I. General information

NPI: 1376682112
Provider Name (Legal Business Name): MCHAEL SEBASTIAN GZIK LICENSED OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E WASHINGTON ST
SYRACUSE NY
13202-1618
US

IV. Provider business mailing address

4213 STREAMWOOD DR
LIVERPOOL NY
13090-1330
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-3937
  • Fax: 315-472-2692
Mailing address:
  • Phone: 315-622-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC003601-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: