Healthcare Provider Details

I. General information

NPI: 1841286465
Provider Name (Legal Business Name): NICHOLAS MICHAEL KAVCSAK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 FRONT ST
BELVIDERE NJ
07823-1512
US

IV. Provider business mailing address

416 FRONT ST
BELVIDERE NJ
07823-1512
US

V. Phone/Fax

Practice location:
  • Phone: 908-475-5757
  • Fax:
Mailing address:
  • Phone: 908-475-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4142/TO 00091
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: