Ethan Boryszak, OD | |
5683 S Transit Rd, Lockport, NY 14094-5844 | |
(716) 631-3860 | |
Not Available |
Full Name | Ethan Boryszak |
---|---|
Gender | Male |
Speciality | Optometrist |
Location | 5683 S Transit Rd, Lockport, New York |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1124060751 | NPI | - | NPPES |
1124060751 | Other | NY | UNIVERA |
NY6999 | Other | NY | EYE MED |
02748149 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | TUV006999-1 (New York) | Primary |
Provider Name | Kenneth G Vandine Mdpc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1881783819 PECOS PAC ID: 5698865996 Enrollment ID: O20071226000015 |
Provider Name | Allegany Ophthalmology Pllc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1760736946 PECOS PAC ID: 8628223732 Enrollment ID: O20130221000049 |
Mailing Address | Practice Location Address |
---|---|
Ethan Boryszak, OD 5683 S Transit Rd, Lockport, NY 14094-5844 Ph: (716) 631-3860 | Ethan Boryszak, OD 5683 S Transit Rd, Lockport, NY 14094-5844 Ph: (716) 631-3860 |
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