Provider Demographics
NPI:1467682914
Name:BZDAFKA, LAURA SAMANTHA (OD)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:SAMANTHA
Last Name:BZDAFKA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3216
Mailing Address - Country:US
Mailing Address - Phone:419-693-4444
Mailing Address - Fax:
Practice Address - Street 1:2740 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616
Practice Address - Country:US
Practice Address - Phone:419-693-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-18
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3126281Medicaid
OHH465031Medicare PIN