Provider Demographics
NPI:1104133636
Name:GRADOWITZ, MINDY SUSAN (OD)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:SUSAN
Last Name:GRADOWITZ
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 1:72 E POST RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4621
Mailing Address - Country:US
Mailing Address - Phone:914-949-8100
Mailing Address - Fax:914-949-8196
Practice Address - Street 1:72 E POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4621
Practice Address - Country:US
Practice Address - Phone:914-949-8100
Practice Address - Fax:914-949-8196
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT4599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist