MEDICARE: DR. ROMUALD KUZA 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	046009902	IL

General Provider Information

NPI Number	:	1225238959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMUALD KUZA O.D.

Provider Business Mailing Address
First Line	:	5352 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1250
Country	:	US
Telephone Number	:	773-777-7444
Fax Number	:	773-775-4030

Provider Business Practice Location Address
First Line	:	5352 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1250
Country	:	US
Telephone Number	:	773-777-7444
Fax Number	:	773-775-4030

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	02/04/2010

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