Provider Demographics
NPI:1770637845
Name:OGONOWSKI, JASON D (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:OGONOWSKI
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 1:42 3RD STREET
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003927152W00000X
NYTUV8372-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04268902Medicaid
FLAF318ZMedicare PIN
NY04268902Medicaid