MEDICARE: BRIAN OLZINSKI OD

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
1	152W00000X	Optometrist	OEG000303	PA

General Provider Information

NPI Number	:	1760476758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN OLZINSKI OD

Provider Business Mailing Address
First Line	:	255 SYCAMORE CT
Second Line	:
City	:	WIND GAP
State	:	PA
Zip	:	18091-9526
Country	:	US
Telephone Number	:	610-703-4307
Fax Number	:

Provider Business Practice Location Address
First Line	:	852 N 9TH ST
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-1206
Country	:	US
Telephone Number	:	570-421-3342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	02/04/2011

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