Provider Demographics
NPI:1942411004
Name:HNATYKO, JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:HNATYKO
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 1:87 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1421
Mailing Address - Country:US
Mailing Address - Phone:973-214-2889
Mailing Address - Fax:
Practice Address - Street 1:399 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2603
Practice Address - Country:US
Practice Address - Phone:201-991-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00457700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1746707Medicaid
NJ677758QA2Medicare ID - Type Unspecified
NJU40795Medicare UPIN