Healthcare Provider Details

I. General information

NPI: 1982752119
Provider Name (Legal Business Name): JOSEPH F KUCZMARSKI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 CLEVELAND DR
CHEEKTOWAGA NY
14225-1042
US

IV. Provider business mailing address

53 RUNNING BROOK DR
LANCASTER NY
14086-3311
US

V. Phone/Fax

Practice location:
  • Phone: 716-836-4949
  • Fax: 716-836-1517
Mailing address:
  • Phone: 716-656-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: