Provider Demographics
NPI:1376682112
Name:GZIK, MCHAEL SEBASTIAN (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:MCHAEL
Middle Name:SEBASTIAN
Last Name:GZIK
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 STREAMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1330
Mailing Address - Country:US
Mailing Address - Phone:315-622-9304
Mailing Address - Fax:
Practice Address - Street 1:116 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1618
Practice Address - Country:US
Practice Address - Phone:315-478-3937
Practice Address - Fax:315-472-2692
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003601-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician