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General NPI Number Information
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NPI Number | 1669095675
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Entity Type | Individual
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Provider Name | KATHLEEN CWIKLA OD
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Gender | Female
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 1523 SADLER RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4467
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Country | US
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Telephone | 904-261-5955
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Fax |
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Provider Business Mailing Address
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Address Line | 2416 LYNNDALE RD STE 201
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5230
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Country | US
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Telephone | 42-615-7419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5785
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License Number State | FL
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