Provider Demographics
NPI:1659450807
Name:MIKOWSKI, WALTER J (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:J
Last Name:MIKOWSKI
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 SENECA STREET
Mailing Address - Street 2:COUNCIL OPTICIANS
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-674-8300
Mailing Address - Fax:716-674-8302
Practice Address - Street 1:3768 SENECA STREET
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-674-8300
Practice Address - Fax:716-674-8302
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4950156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026764001OtherUNIVERA
NYNY4950OtherEYEMED
00026764001OtherUNIVERA