Provider Demographics
NPI:1942495882
Name:ZALESKI OPTICAL GALLERY
Entity Type:Organization
Organization Name:ZALESKI OPTICAL GALLERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-296-4891
Mailing Address - Street 1:322 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1345
Mailing Address - Country:US
Mailing Address - Phone:570-296-4891
Mailing Address - Fax:570-296-4892
Practice Address - Street 1:322 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1345
Practice Address - Country:US
Practice Address - Phone:570-296-4891
Practice Address - Fax:570-296-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAZA1816976OtherHIGHMARK BLUE SHIELD
PA100923Medicare PIN
PAZA1816976OtherHIGHMARK BLUE SHIELD