Provider Demographics
NPI:1902874217
Name:KONICK, DONNA R (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:R
Last Name:KONICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2730
Mailing Address - Country:US
Mailing Address - Phone:315-413-7692
Mailing Address - Fax:315-422-3068
Practice Address - Street 1:1045 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2730
Practice Address - Country:US
Practice Address - Phone:315-413-7692
Practice Address - Fax:315-422-3068
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004912-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7431754OtherAETNA
796636OtherMVP
NY00168680OtherBCBS
2566952OtherUHC
NY928789001OtherHEALTH NOW
NY00168680OtherBCBS