Provider Demographics
NPI:1033248943
Name:KORALEWSKI, KEVIN ALEXANDER (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALEXANDER
Last Name:KORALEWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:K
Other - Middle Name:KORALEWSKI
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2605 E MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5319
Mailing Address - Country:US
Mailing Address - Phone:520-795-0336
Mailing Address - Fax:520-327-5144
Practice Address - Street 1:2605 E MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5319
Practice Address - Country:US
Practice Address - Phone:520-795-0336
Practice Address - Fax:520-327-5144
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ134279OtherPTAN
AZUO2277Medicare UPIN
AZOD 797Medicare ID - Type Unspecified