1083611164 NPI number — GREGORY LORKOWSKI O.D.

Table of content: GREGORY LORKOWSKI O.D. (NPI 1083611164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083611164 NPI number — GREGORY LORKOWSKI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LORKOWSKI
Provider First Name:
GREGORY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083611164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 RED HAWK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EULESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76039-6091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-534-3200
Provider Business Mailing Address Fax Number:
817-536-4835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8115 PRESTON RD
Provider Second Line Business Practice Location Address:
STE 630
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75225-6342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-360-9951
Provider Business Practice Location Address Fax Number:
214-360-9819
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5256TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 041956601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com