Provider Demographics
NPI:1568697548
Name:BUSZKIEWIC, AMY (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BUSZKIEWIC
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 1:7675 S PRESCOTT PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4415
Mailing Address - Country:US
Mailing Address - Phone:615-306-4178
Mailing Address - Fax:
Practice Address - Street 1:7675 S PRESCOTT PL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4415
Practice Address - Country:US
Practice Address - Phone:615-306-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT2719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist