Provider Demographics
NPI:1568635506
Name:OHLIG, GRETCHEN E (OD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:E
Last Name:OHLIG
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 1:101A NORTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1603
Mailing Address - Country:US
Mailing Address - Phone:203-321-9597
Mailing Address - Fax:
Practice Address - Street 1:190 WHEATLEY PLZ
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1316
Practice Address - Country:US
Practice Address - Phone:516-686-6512
Practice Address - Fax:516-277-1591
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2381152W00000X
NYT005447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008053302Medicaid
CTD400183486OtherMEDICARE NGS