Provider Demographics
NPI:1174664361
Name:KOLKMANN, RAYMOND J
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:KOLKMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 HILLSIDE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2521
Mailing Address - Country:US
Mailing Address - Phone:914-245-5151
Mailing Address - Fax:
Practice Address - Street 1:3656 LEE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1512
Practice Address - Country:US
Practice Address - Phone:914-345-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8608156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician