Provider Demographics
NPI:1841761491
Name:WESOLOWSKI, EUGENE EDWARD
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:EDWARD
Last Name:WESOLOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1253
Mailing Address - Country:US
Mailing Address - Phone:585-345-1061
Mailing Address - Fax:585-345-1063
Practice Address - Street 1:4133 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1253
Practice Address - Country:US
Practice Address - Phone:585-345-1061
Practice Address - Fax:585-345-1063
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC009154-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician