Provider Demographics
NPI:1235485749
Name:MALACHOWSKI, MICHAEL F (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:F
Last Name:MALACHOWSKI
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1777 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4624
Mailing Address - Country:US
Mailing Address - Phone:716-674-8446
Mailing Address - Fax:716-674-2682
Practice Address - Street 1:1777 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4624
Practice Address - Country:US
Practice Address - Phone:716-674-8446
Practice Address - Fax:716-674-2682
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003899156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0578410002Medicare UPIN