MEDICARE: KATHLEEN CWIKLA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC5785	FL

General Provider Information

NPI Number	:	1669095675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN CWIKLA OD

Provider Business Mailing Address
First Line	:	2416 LYNNDALE RD STE 201
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-5230
Country	:	US
Telephone Number	:	42-615-7419
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 SADLER RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4467
Country	:	US
Telephone Number	:	904-261-5955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	12/28/2023

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