Provider Demographics
NPI:1013038496
Name:WALTER J. KASPEREK
Entity Type:Organization
Organization Name:WALTER J. KASPEREK
Other - Org Name:EYEWEAR PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KASPEREK
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:607-756-4159
Mailing Address - Street 1:1100 STATE ROUTE 222
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1834
Mailing Address - Country:US
Mailing Address - Phone:607-756-4159
Mailing Address - Fax:607-758-7827
Practice Address - Street 1:1100 STATE ROUTE 222
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1834
Practice Address - Country:US
Practice Address - Phone:607-756-4159
Practice Address - Fax:607-758-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000023063OtherBC BS EXCELLUS
NY0199670001Medicare ID - Type Unspecified