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General NPI Number Information
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NPI Number | 1497064349
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Entity Type | Organization
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Legal Business Name | ELI KACZYNSKI MD PS
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 2529 W FALLS AVE
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City | KENNEWICK
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State | WA
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Zip | 99336-3041
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Country | US
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Telephone | 509-783-3161
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Fax | 509-783-3163
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Provider Business Mailing Address
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Address Line | 2529 W FALLS AVE
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City | KENNEWICK
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State | WA
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Zip | 99336-3041
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Country | US
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Telephone | 509-783-3161
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Fax | 509-783-3163
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Authorized Official
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Title or Position | CORPORATE PRESIDENT
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Name | DR. ELI NMI KACZYNSKI
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Credential | MD
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Telephone | 509-783-3161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD00016765
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License Number State | WA
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