Provider Demographics
NPI:1083611164
Name:LORKOWSKI, GREGORY (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:LORKOWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 RED HAWK LN
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-6091
Mailing Address - Country:US
Mailing Address - Phone:817-534-3200
Mailing Address - Fax:817-536-4835
Practice Address - Street 1:8115 PRESTON RD
Practice Address - Street 2:STE 630
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6342
Practice Address - Country:US
Practice Address - Phone:214-360-9951
Practice Address - Fax:214-360-9819
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5256TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041956601Medicaid
TX041956601Medicaid
TXU66330Medicare UPIN