Provider Demographics
NPI:1063650257
Name:DR. O. GREGORY ZAZULAK, MD, PC
Entity Type:Organization
Organization Name:DR. O. GREGORY ZAZULAK, MD, PC
Other - Org Name:FINGER LAKES EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:O. GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAZULAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:315-462-7694
Mailing Address - Street 1:6 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1213
Mailing Address - Country:US
Mailing Address - Phone:315-462-7694
Mailing Address - Fax:315-462-5248
Practice Address - Street 1:6 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1213
Practice Address - Country:US
Practice Address - Phone:315-462-7694
Practice Address - Fax:315-462-5248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178871207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12167BMedicare PIN