Provider Demographics
NPI:1548210131
Name:FLAITZ, GREGORY J (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:FLAITZ
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 1:7899 STATE ROUTE 21
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-9669
Mailing Address - Country:US
Mailing Address - Phone:605-200-2325
Mailing Address - Fax:
Practice Address - Street 1:987 R C HOAG DR
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1365
Practice Address - Country:US
Practice Address - Phone:716-945-5894
Practice Address - Fax:716-242-6345
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD558152W00000X
AK235152W00000X
NYRT006640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10566229OtherIHA
NY4107243OtherAMERIGROUP
SD430083OtherMEDICARE ID
NY000538823002OtherBCBS
NY04372932Medicaid