Provider Demographics
NPI:1295272953
Name:CREIGHTON OPTICAL
Entity type:Organization
Organization Name:CREIGHTON OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKRZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-937-7373
Mailing Address - Street 1:13295 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1324
Mailing Address - Country:US
Mailing Address - Phone:716-937-7373
Mailing Address - Fax:716-937-4136
Practice Address - Street 1:13295 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1324
Practice Address - Country:US
Practice Address - Phone:716-937-7373
Practice Address - Fax:716-937-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty