Provider Demographics
NPI:1790348720
Name:DZURINKO EYE CARE SPECIALIST, LLC
Entity Type:Organization
Organization Name:DZURINKO EYE CARE SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DZURINKO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-994-0506
Mailing Address - Street 1:PO BOX 5401
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-0401
Mailing Address - Country:US
Mailing Address - Phone:412-994-0506
Mailing Address - Fax:856-579-4354
Practice Address - Street 1:1710 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2010
Practice Address - Country:US
Practice Address - Phone:856-537-7214
Practice Address - Fax:856-579-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH0786OtherEYEMED