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NPI Code Detail

MEDICARE: JOHN M. BRZEZICKI, JR., O.D.

MEDICARE: JOHN M. BRZEZICKI, JR., O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristTU002605-1NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1441540262OTHERNYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164728952
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN M. BRZEZICKI, JR., O.D.
Provider Business Mailing Address
First Line : 6421 W QUAKER ST
Second Line :
City : ORCHARD PARK
State : NY
Zip : 14127-2354
Country : US
Telephone Number : 716-662-4525
Fax Number :
Provider Business Practice Location Address
First Line : 6421 W QUAKER ST
Second Line :
City : ORCHARD PARK
State : NY
Zip : 14127-2354
Country : US
Telephone Number : 716-662-4525
Fax Number : 716-662-4138
Authorized Official
Title or Position : OPTOMETRIST
Name : DR. JOHN MYRON BRZEZICKI JR.
Credential : O.D.
Telephone Number : 716-662-4525
Provider Enumeration Date : 01/27/2011
Last Update Date : 01/27/2011

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