Provider Demographics
NPI:1497736227
Name:ZELAZOWSKI, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ZELAZOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-1448
Mailing Address - Country:US
Mailing Address - Phone:724-274-8383
Mailing Address - Fax:724-274-3206
Practice Address - Street 1:1423 PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:CHESWICK
Practice Address - State:PA
Practice Address - Zip Code:15024-1448
Practice Address - Country:US
Practice Address - Phone:724-274-8383
Practice Address - Fax:724-274-3206
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG7152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4063390001OtherDEMERC
138595OtherEYEMED
PA001806272000Medicaid
0017540OtherDORAL
21149OtherCLARITY VISION
PA825201OtherHIGHMARK
150874OtherHEALTH ASSURANCE
311359OtherUPMC
138595OtherCOLE MANAGED VISION
150874OtherHEALTH AMERICA
150874OtherADVANTA
397307OtherNVA
397307OtherNVA
0017540OtherDORAL
150874OtherHEALTH ASSURANCE
397307OtherNVA