Individual
ETHAN BORYSZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV006999-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02748149
—
NY
01
—
1124060751
UNIVERA
NY
01
—
NY6999
EYE MED
NY
Enumeration date
06/11/2006
Last updated
10/16/2008
Update your record
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