Provider Demographics
NPI:1043326085
Name:BUCZKOWSKI, PATRICK RAYMOND (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:RAYMOND
Last Name:BUCZKOWSKI
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 SE STEVENS CT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4707
Mailing Address - Country:US
Mailing Address - Phone:503-353-7300
Mailing Address - Fax:
Practice Address - Street 1:12100 SE STEVENS CT
Practice Address - Street 2:SUITE 106
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4707
Practice Address - Country:US
Practice Address - Phone:503-353-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician