Active NPI
Michael Thomas Dulak, OPTICIAN
- Optician
- Blasdell, NY
National Provider Identifier
1689701005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 3845
- Practice address
- 3876 South Park Ave
Blasdell, NY 14219 - Phone
- (716) 822-2264
- Fax
- (716) 826-3068
- NPI assigned
- Feb 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 3845 | NY | Primary |
Addresses
Primary practice location
3876 South Park Ave
Blasdell, NY 14219
Mailing address
57 Sawgrass CT
Hamburg, NY 14075
Phone (716) 649-0436
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00917226 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3845 | NY | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Sher Optical Co of Buffalo Ny Inc | Optician | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689701005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "57 SAWGRASS CT",
"city": "HAMBURG",
"state": "NY",
"postal_code": "14075",
"telephone_number": "716-649-0436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3876 SOUTH PARK AVE",
"city": "BLASDELL",
"state": "NY",
"postal_code": "14219",
"telephone_number": "716-822-2264",
"fax_number": "716-826-3068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DULAK",
"first_name": "MICHAEL",
"middle_name": "THOMAS",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "3845",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00917226",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blasdell, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.