Provider Demographics
NPI:1578627402
Name:PRUZINSKY, JOSEPH GARY (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH GARY
Middle Name:
Last Name:PRUZINSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CHANEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1908
Mailing Address - Country:US
Mailing Address - Phone:570-489-4788
Mailing Address - Fax:
Practice Address - Street 1:103 CHANEY DRIVE
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1908
Practice Address - Country:US
Practice Address - Phone:570-489-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007359T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18868Medicare ID - Type Unspecified
U30623Medicare UPIN