Provider Demographics
NPI:1851371298
Name:GRZANKOWSKI, DONALD P (OD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:GRZANKOWSKI
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 1:168 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2735
Mailing Address - Country:US
Mailing Address - Phone:716-372-9464
Mailing Address - Fax:
Practice Address - Street 1:168 N UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2735
Practice Address - Country:US
Practice Address - Phone:716-372-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002749-I-U152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55144EMedicare ID - Type UnspecifiedUPSTATE MEDICARE
NY38645IMedicare ID - Type UnspecifiedUPSTATE MEDICARE
NYB53811Medicare PIN
NY39008EMedicare ID - Type UnspecifiedUPSTATE MEDICARE
NYD53815Medicare ID - Type UnspecifiedUPSTATE MEDICARE