Provider Demographics
NPI:1801985155
Name:WESOLOWSKI, VINCENT A (OD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:WESOLOWSKI
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 1:2630 CROPSEY AVE
Mailing Address - Street 2:16 H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8949 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6437
Practice Address - Country:US
Practice Address - Phone:718-372-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 003515-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3677257OtherOXFORD
7937476OtherAETNA
NY02334201Medicaid
NYCTF17C2151Medicare PIN
NYCTF170Medicare PIN