Provider Demographics
NPI:1154052348
Name:GAZDOVICH, IRINA (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:GAZDOVICH
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-8501
Mailing Address - Country:US
Mailing Address - Phone:864-814-1231
Mailing Address - Fax:864-814-1233
Practice Address - Street 1:4000 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-8501
Practice Address - Country:US
Practice Address - Phone:864-814-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician