Provider Demographics
NPI:1295860625
Name:TABACZYNSKI, ARTHUR F (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:F
Last Name:TABACZYNSKI
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 ROSEMEAD LN
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1329
Mailing Address - Country:US
Mailing Address - Phone:716-894-5866
Mailing Address - Fax:
Practice Address - Street 1:3035 GENESEE ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2661
Practice Address - Country:US
Practice Address - Phone:716-896-3351
Practice Address - Fax:716-896-0171
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003434-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC003434-1OtherOPHTHALMIC LICENSE
NYNY3434OtherEYEMED