Provider Demographics
NPI:1568828663
Name:JASON OGONOWSKI, OD, PLLC
Entity Type:Organization
Organization Name:JASON OGONOWSKI, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:OGONOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-274-8181
Mailing Address - Street 1:42 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3906
Mailing Address - Country:US
Mailing Address - Phone:518-274-8181
Mailing Address - Fax:518-272-8164
Practice Address - Street 1:42 3RD ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3906
Practice Address - Country:US
Practice Address - Phone:518-274-8181
Practice Address - Fax:518-272-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV8372152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty