Healthcare Provider Details

I. General information

NPI: 1174694681
Provider Name (Legal Business Name): MR. DENNIS OSIAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 TRANSIT RD EASTERN HILLS MALL
WILLIAMSVILLE NY
14221-6012
US

IV. Provider business mailing address

4545 TRANSIT RD EASTERN HILLS MALL
WILLIAMSVILLE NY
14221-6012
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-5497
  • Fax: 716-632-1182
Mailing address:
  • Phone: 716-632-5497
  • Fax: 716-632-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberC0036231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: