Provider Demographics
NPI:1326034240
Name:BOBOWSKI, CASIMIR KAROL (OD)
Entity Type:Individual
Prefix:DR
First Name:CASIMIR
Middle Name:KAROL
Last Name:BOBOWSKI
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 1:1342 NEW SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-8802
Mailing Address - Country:US
Mailing Address - Phone:315-685-6185
Mailing Address - Fax:315-685-2235
Practice Address - Street 1:1342 NEW SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-8802
Practice Address - Country:US
Practice Address - Phone:315-685-6185
Practice Address - Fax:315-685-2235
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0042591152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50018BMedicare PIN
NY0240450001Medicare NSC
NYT26649Medicare UPIN