MEDICARE: DR. STEVE KASPRZAK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1553-584T	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174718340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVE KASPRZAK O.D.

Provider Business Mailing Address
First Line	:	1234 ABBOTT RD STE 13
Second Line	:
City	:	LACKAWANNA
State	:	NY
Zip	:	14218-1944
Country	:	US
Telephone Number	:	716-770-5970
Fax Number	:	716-219-1176

Provider Business Practice Location Address
First Line	:	642 SHERIDAN DR
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-7853
Country	:	US
Telephone Number	:	716-695-3733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	12/09/2019

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