Healthcare Provider Details

I. General information

NPI: 1225238959
Provider Name (Legal Business Name): ROMUALD KUZA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 N MILWAUKEE AVE
CHICAGO IL
60630-1250
US

IV. Provider business mailing address

5352 N MILWAUKEE AVE
CHICAGO IL
60630-1250
US

V. Phone/Fax

Practice location:
  • Phone: 773-777-7444
  • Fax: 773-775-4030
Mailing address:
  • Phone: 773-777-7444
  • Fax: 773-775-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009902
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: