Healthcare Provider Details

I. General information

NPI: 1407078470
Provider Name (Legal Business Name): LORI ANN KUCIA-PARK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 13TH AVENUE
DELANO CA
93215-2202
US

IV. Provider business mailing address

919 13TH AVENUE
DELANO CA
93215-2202
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-3795
  • Fax: 661-725-3797
Mailing address:
  • Phone: 661-725-3795
  • Fax: 661-725-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 11801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: