Provider Demographics
NPI:1750855573
Name:PAWLOWSKI, ROBERT JOHN
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:PAWLOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:JOHN
Other - Last Name:PAWLOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3290 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1422
Mailing Address - Country:US
Mailing Address - Phone:716-691-1192
Mailing Address - Fax:716-834-2365
Practice Address - Street 1:3290 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1422
Practice Address - Country:US
Practice Address - Phone:716-691-1192
Practice Address - Fax:716-834-2365
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003339156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician