Doctor Name: | MR. PATRICK RAYMOND BUCZKOWSKI |
NPI Number: | 1043326085 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OPTICIAN |
License Number: | |
Business Practice Address: | 12100 Se Stevens Ct Suite 106 Happy Valley, OR - 970864707 |
Business Phone Number: | 5033537300 |
Business Fax Number: | |
Mailing Address: | 12100 Se Stevens Ct, Suite 106 HAPPY VALLEY |
State: | OR |
Postal Code: | 970864707 |
Phone Number: | 5033537300 |
Fax Number: | |
NPI Enumeration Date: | 08/22/2006 |
NPI Last Update Date: | 02/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |