Provider Demographics
NPI:1700812849
Name:DZIUBEK, GREGORY EDWIN (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDWIN
Last Name:DZIUBEK
Suffix:
Gender:M
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:PO BOX 101475
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-8475
Mailing Address - Country:US
Mailing Address - Phone:412-337-2155
Mailing Address - Fax:724-933-4608
Practice Address - Street 1:706 BRISTLECONE DR
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-6135
Practice Address - Country:US
Practice Address - Phone:412-337-2155
Practice Address - Fax:724-933-4608
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001569187 0005Medicaid
PA730318Medicare PIN
PA001569187 0005Medicaid