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General NPI Number Information
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NPI Number | 1841761491
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Entity Type | Individual
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Provider Name | EUGENE EDWARD WESOLOWSKI
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Gender | Male
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 4133 VETERANS MEMORIAL DR
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City | BATAVIA
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State | NY
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Zip | 14020-1253
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Country | US
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Telephone | 585-345-1061
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Fax | 585-345-1063
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Provider Business Mailing Address
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Address Line | 4133 VETERANS MEMORIAL DR
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City | BATAVIA
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State | NY
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Zip | 14020-1253
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Country | US
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Telephone | 585-345-1061
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Fax | 585-345-1063
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | C009154-1
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License Number State | NY
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