Provider Demographics
NPI:1023593936
Name:GREDZIK, MICHAEL J (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GREDZIK
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 1:2828 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4710
Mailing Address - Country:US
Mailing Address - Phone:215-939-6966
Mailing Address - Fax:
Practice Address - Street 1:1006 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2836
Practice Address - Country:US
Practice Address - Phone:610-544-3828
Practice Address - Fax:610-544-3695
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty