Healthcare Provider Details

I. General information

NPI: 1164501458
Provider Name (Legal Business Name): GREGORY P. GACHOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GREGORY P. GACHOWSKI OD

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 PARK ST
TUPPER LAKE NY
12986-1719
US

IV. Provider business mailing address

PO BOX 1197
TUPPER LAKE NY
12986-0197
US

V. Phone/Fax

Practice location:
  • Phone: 518-359-2161
  • Fax: 518-359-2168
Mailing address:
  • Phone: 518-359-2161
  • Fax: 518-359-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV003743-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: