Provider Demographics
NPI:1053312579
Name:KALUZNE, STEPHEN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:KALUZNE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 ASHLEYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2917
Mailing Address - Country:US
Mailing Address - Phone:336-774-1770
Mailing Address - Fax:336-774-1130
Practice Address - Street 1:1330 ASHLEYBROOK LN
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2917
Practice Address - Country:US
Practice Address - Phone:336-774-1770
Practice Address - Fax:336-774-1130
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0973152W00000X, 152WC0802X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5773141OtherAETNA
NCA0844OtherMEDCOST
NC0949NOtherBCBS
NC22-01918OtherUNHC
NC5763OtherPARTNERS
NC8909469Medicaid
NC5773141OtherAETNA
NC8909469Medicaid
NCT64820Medicare UPIN