Provider Demographics
NPI:1073624433
Name:KULBA, JANICE (OD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:KULBA
Suffix:
Gender:F
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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-0099
Mailing Address - Country:US
Mailing Address - Phone:609-953-7080
Mailing Address - Fax:
Practice Address - Street 1:525 ROUTE 72 W
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2821
Practice Address - Country:US
Practice Address - Phone:609-978-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA 00520100152W00000X
PA7418-P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist