Provider Demographics
NPI:1649398298
Name:WOSZCZAK, IRENA MARIA (OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:IRENA
Middle Name:MARIA
Last Name:WOSZCZAK
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:BROADWAY
Other - Middle Name:
Other - Last Name:OPTICIANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:999 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-1369
Mailing Address - Country:US
Mailing Address - Phone:716-892-9373
Mailing Address - Fax:716-892-8316
Practice Address - Street 1:999 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1369
Practice Address - Country:US
Practice Address - Phone:716-892-9373
Practice Address - Fax:716-892-8316
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5635-1156FC0801X
NY5635156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY140943OtherCOLE VISION
NY49661OtherDAVIS VISION
NY00011278301OtherUNIVERA
NY000390186005OtherBLUE CROSS BLUE SHIELD OF
NY01343728Medicaid
NYNY5635OtherEYEMED VISION CARE