Provider Demographics
NPI:1174694681
Name:OSIAK, DENNIS
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:OSIAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 TRANSIT RD
Mailing Address - Street 2:EASTERN HILLS MALL
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6012
Mailing Address - Country:US
Mailing Address - Phone:716-632-5497
Mailing Address - Fax:716-632-1182
Practice Address - Street 1:4545 TRANSIT RD
Practice Address - Street 2:EASTERN HILLS MALL
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6012
Practice Address - Country:US
Practice Address - Phone:716-632-5497
Practice Address - Fax:716-632-1182
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC0036231156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00608851Medicaid