Provider Demographics
NPI:1164501458
Name:GACHOWSKI, GREGORY P
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:GACHOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:P
Other - Last Name:GACHOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 1197
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-0197
Mailing Address - Country:US
Mailing Address - Phone:518-359-2161
Mailing Address - Fax:518-359-2168
Practice Address - Street 1:82 PARK ST
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-1719
Practice Address - Country:US
Practice Address - Phone:518-359-2161
Practice Address - Fax:518-359-2168
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003743-1152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26489Medicare UPIN
NY0598870001Medicare NSC
NY37687BMedicare PIN