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General NPI Number Information
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NPI Number | 1568828663
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Entity Type | Organization
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Legal Business Name | JASON OGONOWSKI, OD, PLLC
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 42 3RD ST
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City | TROY
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State | NY
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Zip | 12180-3906
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Country | US
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Telephone | 518-274-8181
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Fax | 518-272-8164
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Provider Business Mailing Address
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Address Line | 42 3RD ST
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City | TROY
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State | NY
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Zip | 12180-3906
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Country | US
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Telephone | 518-274-8181
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Fax | 518-272-8164
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. JASON OGONOWSKI
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Credential | OD
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Telephone | 518-274-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV8372
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License Number State | NY
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