Provider Demographics
NPI:1720240559
Name:CASIMIR K BOBOWSKI OD
Entity Type:Organization
Organization Name:CASIMIR K BOBOWSKI OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASIMIR
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-685-6185
Mailing Address - Street 1:1342 NEW SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-8802
Mailing Address - Country:US
Mailing Address - Phone:315-685-6185
Mailing Address - Fax:315-685-2235
Practice Address - Street 1:1342 NEW SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-8802
Practice Address - Country:US
Practice Address - Phone:315-685-6185
Practice Address - Fax:315-685-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0042591332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0240450001Medicare NSC